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COPYRIGHT DEPOSIT. 



The Parent's Library 

Nine Volumes, Uniformly Bound. 12 mo. 
Cloth. Per Volume, $1.50 



First Steps in Child Training 

By PROFESSOR M. V. O'SHEA 

The Trend of the Teens 

By PROFESSOR M. V. O'SHEA 

Faults of Childhood and Youth 
By PROFESSOR M. V. O'SHEA 

Everyday Problems in Child Training 

By PROFESSOR M. V. O'SHEA 

Putting Young America in Tune 

How to Teach the Child Appreciation 
of Music 

By HENRIETTE WEBER 

The Home Guide to Good Reading 

With Notes 

By PROFESSOR DAVID HARRISON 
STEVENS 

The Proper Feeding of Infants 

By W. H. GALLAND, M. D. 

Diseases of Infancy and Childhood 

By W. H. GALLAND, M. D. 

Maternity and Child Care 

The Lives of Mothers and Children, 

How We Can Save Them 

By W. H. GALLAND, M. D. 






How the Germs Which Cause Some of the Common Diseases 

of Infancy and Childhood Look Under the Microscope. 

Upper Row — Tuberculosis, Pneumonia, Influenza. 

Center Row — Diphtheria, Whooping Cough, 

Typhoid Fever. Lower Row — Form of 

Ptomain, Lock-Jaw, Malaria. 



Gbe parent's Xibrars 

i. 

Diseases of Infancy 
and Childhood 



W. H. GALLAND, M. D. 

Medical Director 

Mother's Magazine and Home Life 



CHICAGO 

FREDERICK J. DRAKE & CO, 

Publishers 




Copyright, 1920 

By Frederick J. Drake & Co., 

Chicago 

All Rights Reserved 



©CI.A604347 



^D 



£be parent's Xibrars 

A series of practical books relating to the care and culture 
of the young, published under the editorial supervision of 
Professor M. V. O'Shea of the University of Wisconsin, Edu- 
cational Director, and Mr. Paul E. Watson, Editorial Direc- 
tor, of Mother's Magazine and Home Life, in cooperation with 
which magazine this Library has been prepared. 



PBEFACE 

This book has been written with five distinct 
purposes in mind. First, to point out that the 
important thing in the treatment of the child dur- 
ing any illness is careful nursing. Second, that 
many children are sickly and suffer from repeated 
illness when all that is needed to bring them to a 
state of good health is careful regulation of the 
diet, plenty of rest, the correct daily hygiene and 
fresh air day and night. Third, that after any 
illness diligent and watchful care during con- 
valescence are as necessary as in the acute stage 
of the disease. Fourth, that the child who 
remains persistently run down in spite of all 
possible care of diet and hygiene, should have 
the most searching examination, made by a com- 
petent physician, for some masked disease or 
hidden source of poison. Fifth, that in all infec- 
tious diseases of childhood, not only the sick child 
is to be considered but those about him. It is the 
conscientious and proper quarantine of one child 
that will save hundreds of others from becoming 
victims of the same disease. It has been well said 
that it is only when the public will work hand 

13 



14 PREFACE 

in hand intelligently and earnestly with the scien- 
tist that disease can be stamped out. 

No attempt is made in this book to discuss 
the unusual diseases of childhood but only those 
that are an everyday problem in .many homes. 
Much splice has been devoted to the true source 
and nature of many diseases in order that the 
mother may be able to manage with more enlight- 
enment these critical times in the child's life. 
It is the care of every detail in nursing during 
illness that will bring its reward. A famous phy- 
sician at seventy said: "All the humiliating 
experiences of my practice came when I let down 
a little — got a little careless in some detail." 

And, finally, it must be remembered that the 
exact nature of a child's illness is sometimes 
difficult to discover ; a physician may need to see 
a child many times and make many careful exam- 
inations before the right treatment can be deter- 
mined upon to remove the possible sources of the 
trouble. 

William Herbert Galland. 
Glengary Hall, 
Mount Airy, 
Croton-on-Hudson, 



TABLE OF CONTENTS 

CHAPTER PAG® 

I Nursing the Sick Child ,. 17 

II Malnutrition 35 

III Diphtheria 44 

IV Scarlet Fever 55 

V Measles 65 

VI Chicken-Pox 75 

VII Mumps . . . 78 

VIII Whooping-Cough 81 

IX Vaccination 88 

X Infantile Paralysis 93 

XI Colds, Catarrh, Croup, Influenza and 

Their Complications .103 

XII Tonsils and Adenoid Growths 119 

XIII Bronchitis 133 

XIV Pneumonia . 138 

XV Pleurisy 146 

XVI Asthma and Hay Fever . . 149 

XVII Tuberculosis 155 

XVIII The Eye and Ear 170 

XIX Diseases of the Mouth, Stomach and 

Intestines 189 

XX Food Poisoning 214 

XXI Typhoid Fever . * .223 

XXII The Kidneys and Bladder 236 

XXIII Diseases of the Skin and Nervous 

System 247 



TABLE OF CONTENTS 
CHAPTER PAGE 

XXIV Rheumatism in Children 271 

XXV Heart Disease in Children 284 

XXVI Malaria 295 

XXVII Scurvy 299 

XXVIII Rickets 304 

XXIX Deformities 313 

XXX Acidosis .321 

Appendix 324 

Index 332 



DISEASES OF INFANCY AND 
CHILDHOOD 

CHAPTER I 
NURSING THE SICK CHILD 

Every child begins an illness with a certain 
amount of fighting strength and the main duty 
of the nurse is to conserve every particle of this 
strength that its full force may be used to resist 
the disease and hasten recovery. 

Quiet, rest, fresh air, plenty of water, diet in 
accordance with the digestive capacity of the sick 
child, with calm, cheerful regularity in the sick- 
room routine on the part of the mother or nurse 
— these are the chief requirements for the suc- 
cessful management of all the diseases of child- 
hood. 

Fear, fretfulness and irritability use up more 
strength than running about, therefore, the 
important measure of putting the sick child to 
bed loses its full value unless the child is kept 
comfortable and calm by all the means the mother 
can command. 

17 



18 DISEASES OF INFANCY 

The child whose daily life and habits have 
been carefully regulated from babyhood usually 
makes the best patient. Regularity in feeding, 
sleep, the bath, bowel movements and outdoor 
exercise in the baby; continued through the run- 
about and school age, is the home order which 
produces the healthy, disciplined, contented child 
who, in sickness, gives the least cause for anxiety 
and recuperates with the least loss of time and 
strength. 

On the other hand, the child whose daily 
hygiene is not regulated with precision, who 
through lack of discipline or over-attention, is 
fussy, excitable and hard to manage, is the one 
whose store of nervous and physical energy is 
rapidly exhausted in sickness and whose fighting 
strength often proves insufficient to combat 
disease. 

Intelligent nursing is the essential safeguard. 
Many a sick child who has been ailing for months 
has recovered promptly when the simple details 
of daily life have been firmly and intelligently 
directed. 

THE SICK-ROOM 

Most illnesses of childhood are infectious, 
therefore, the sick-room should contain only 
simple and necessary furnishings. Heavy drap- 
eries, rugs, upholstered furniture, all things not 
easily disinfected, should be removed. 



NURSING THE SICK CHILD 19 

Fresh air without draughts must be had con- 
stantly day and night. In winter choose the 
sunny room; in summer the cooler one. Use 
the room with painted or kalsomined walls rather 
than papered ones. In warm weather the win- 
dows should be carefully screened from flies and 
should be kept wide open day and night, the bed 
shielded from draught by a screen. In cold 
weather a temporary window board can be made 
by sawing a plain six- or eight-inch board the 
width of the window and placing it under the 
lower sash. Air then enters in an upward course 
between the two sashes. If there is not a ven- 
tilator in the room, or an open fireplace which 
is one of the best outlets for foul air, the up-cur- 
rent of stale air should be let out through the 
top of one of the other windows, guarding the 
child >s bed from any down-draught caused by 
the wind. 

This matter of ventilation is vital in the sick- 
room because the child's resistance to the disease 
is directly dependent upon the amount of oxygen 
his lungs receive. Never put a child, sick or well, 
in an alcove or corner where the air is stagnant. 
Proper ventilation can only be secured by three 
means; (1) an inlet for fresh air, (2) an outlet 
for foul air, (3) a means to keep the air in 
motion. 

A sick child must not be held, rocked, need- 
lessly handled, or fussed over with something 



20 DISEASES OF INFANCY 

being done for him every hour. This exhausts 
his reserve of strength. Food and medicine 
should be given, at the same time when possible, 
without stir or commotion. The child's fears 
and fretfulness should be quieted and only one 
person allowed in the room at a time. 

He should be put in a freshly made, well-aired 
bed at the first signs of sickness, with light- 
weight but sufficiently warm covering and the 
usual night clothes. (Never bundle up the sick 
child in woolen shawls and jackets.) Extra cloth- 
ing is not required during the day when the room 
temperature is kept between 65° and 7.0° F. At 
night the room may be considerably cooler, extra 
covering may be put on the bed and a knit cap on 
the child's head. (This is very essential in pneu- 
monia, diphtheria, bronchitis and tuberculosis.) 
In summer the clothing should be light ; the baby 
requiring but a thin slip and diaper. The room 
temperature in winter should be 66° to 68° under 
most conditions, never above 70°. 

The child with fever breathes more rapidly 
than usual, uses up more oxygen and throws off 
more carbonic dioxide and, therefore, in impure 
air gets restless, depressed and has only half a 
chance for recovery. The sick-room should never 
be without a thermometer and the temperature 
should be carefully watched and regulated. 
Fresh air does not have to be cold air- and while 
many believe in the cold-air treatment for pneu- 



NURSING THE SICK CHILD 21 

monia it is not necessary if plenty of warm fresh 
air is supplied. 

The bed sheets should always be kept smooth 
and unwrinkled beneath the sick child and his 
position in bed changed from time to time to 
prevent bed-soreness. 

BATHING 

Bathing is more vital in sickness than in health 
because the diseased system is constantly throw- 
ing off its poisons through the pores and these 
must be kept open and clean. Bathing is the 
best means for reducing fever in the sick-child. 

The Sponge Bath. — This should be given once 
or twice a day; oftener in summer and when the 
high temperature of the fever needs reducing. It 
should be given under the bed-clothes, causing 
the child no effort and exposing only part of the 
body at a time. For the cleansing bath, sponge 
gently with warm water, soft cloth and a little 
soap, drying gently without rubbing. In hot 
weather use cooler water and allow it to evapor- 
ate from the skin, in this way getting rid of some 
of the body heat. When the child is restless and 
sleepless with fever, sponge the entire body, 
using one-third alcohol and two-thirds water; 
allowing it to evaporate from the skin. 

It is impossible to say how high the tempera- 
ture should be before the cooling sponge bath is 
given. One or two degrees of fever make some 



22 DISEASES OF INFANCY 

children very restless, others can tolerate three 
or four before it tells on the nervous system. If 
the fever continues to cause discomfort, several 
sponge baths can be given daily. In measles 
or scarlet fever, although the temperature may 
not be very high, the itching and burning prevent 
sleep and greatly irritate the child. Then care- 
ful sponging with water at 75° to 80° F. will often 
induce rest and sleep. In pneumonia, typhoid 
fever and intestinal disorders, cool sponging for 
ten or fifteen minutes has a soothing effect upon 
the patient. For the sick baby during the hot 
days the cool sponge at 65° to 75° is a valuable 
relief. . 

The careful sponge without exposure, and the 
brisk rub afterward if the weather is cool, is a 
safe means for the unskilled nurse to employ, 
while the cold pack or tub bath should only be 
given the sick child by one trained in its use. 

Timid or nervous children should be sponged 
at first with water heated to 95° or 98° (the 
body temperature) so as not to frighten or annoy 
them. This can be cooled with ice or cold water 
gradually, never below 60° unless your physician 
directs it. Never take longer than twenty min- 
utes or exhaust the child with too frequent 
spongings. 

The Salt Bath. — This stimulates the skin to 
sharp reaction when it is failing to act properly. 
Use one tablespoonful of common salt in a gal- 



NURSING THE SICK CHILD . 23 

Ion of water at 85° to 90° F. Bub the skin briskly 
after the bath. This is beneficial for the con- 
valescing child and for one who is delicate and 
poorly nourished. It is a good tonic to apply 
after the regular cleansing bath of soap and 
water and the child can remain in it five or ten 
minutes, the skin being constantly rubbed with 
a stout cloth to stimulate the circulation. The 
brine bath must not be given in case of eczema 
or any inflamed condition of the skin. 

The Soda Bath. — This gives relief in cases of 
prickly heat or hives. Put one tablespoonful of 
bi-carbonate, or baking soda in each half-gallon 
of water of the usual temperature. Let the child 
stay in three or four minutes and dry the skin 
without friction by patting with a soft towel. 

The Bran Bath. — This can be given for the 
same purpose, using one cup of bran to the half- 
gallon of water; or a half -cupful of powdered 
laundry starch can be used. 

The Mustard Bath. — This bath is useful for 
the treatment of convulsions and to induce sleep. 
Use one heaping tablespoonful of mustard in 
six gallons of water; let the child stay in two 
or three minutes, rub quickly and put imme- 
diately to bed. 

The Tub Bath. — This is valuable for reducing 
fever and should only be used on the physician's 
orders. Start it at a temperature of 95°, reduce 
gradually by adding cold water to 80° or 75° F. 



24' DISEASES OF INFANCY 

The child should not stay in longer than 'ten 
minutes with constant brisk rubbing. 

The Hot Tub Bath. — If this is ordered for the 
sick child it is given from three to five minutes 
at a temperature of 102° to 110° F., with con- 
stant rubbing of the hands and feet. 

DRINKING WATER 

The system needs drinking water in abundance 
at all times, a greater amount in sickness than 
in health. There is no disease of childhood that 
is not benefitted by plenty of drinking water, 
given cool and pure; always boiled for babies if 
there is any question about its purity. Vichy 
and Lithia water, because of their alkali salts, 
are excellent for the sick child when an acid state 
calls for the introduction of alkalies. There are 
other medicinal waters which are beneficial. 

FOOD 

In all illness the strength of the food must 
be reduced. The poisons of the disease circulat- 
ing in the system together with the fever and 
prostration unfit the digestive organs and weaken 
them. 

The sick baby should receive barley or oatmeal 
water from the nursing bottle before each feed- 
ing and the usual amount of milk should be 
reduced one-half. When the trouble is in the 
intestines as in summer diarrhea, all the milk 



NURSING THE SICK CHILD 25 

must be stopped for thirty-six hours and only 
plain or cereal water given as directed. In 
typhoid fever milk is not well taken and cereal 
water and gruels are substituted. In older babies 
cane or milk sugar is added to cereal water in 
a limited amount to supply nourishment. In 
babies under three months plain water must be 
used — not cereal water. 

Too much milk fed to the sick child decomposes 
in the bowels, forms gas, presses against the 
lungs interfering with breathing and also cramps 
the heart. This is very serious in diseases of 
the lungs and heart. Moreover, the system is 
compelled to fight not alone the poisons of the 
disease but the extra poisons thrown off by the 
decomposing food which add greatly to the sick 
child's restlessness and discomfort. 

THE TJKISTE AND BOWELS 

In all acute infectious diseases the careful 
physician makes frequent examinations of the 
urine, because there is always more or less dan- 
ger that the poisons may invade the kidneys and 
produce Bright 's disease. One of the earliest 
signs of this complication is albumin in the urine. 
Prompt treatment will generally avert serious 
trouble. 

In every illness of childhood it is essential to 
open the bowels at once to allow the poisons to 
escape. The best means is a large dose of castor 



26 DISEASES OF INFANCY 

oil. After this the bowels must be kept open 
daily by adequate doses of milk of magnesia, or 
rhubarb and soda, aromatic cascara or of the 
mineral oils. 

TEMPEKATTJKE 

The temperature of the sick child should be 
taken regularly and a clinical thermometer should 
be procured for this purpose. The normal tem- 
perature in health, taken by the mouth, is 98y 2 ° 
F. In babies and young children, who might bite 
the thermometer, the temperature must be taken 
by the rectum and this is about one degree higher, 
99^°. Babies easily get one or two degrees of 
fever from crying, constipation or indigestion, 
but this promptly subsides when the error is 
corrected. Nervous or excitable children easily 
run a little fever from over-play which quickly 
disappears with a short rest. An overloaded 
stomach or fermenting food in the intestines will 
produce 1° or iy 2 ° of fever. But when your 
child is listless or irritable, has little or no appe- 
tite, complains of headache or pains in any part 
of the body, take the temperature. 

As soon as you discover fever, and it may 
come on suddenly, put the child to bed, give one 
of the cathartics, cut the diet down to gruels or 
strained vegetable broth, milk, water or lemonade 
for twenty-four hours. This prompt treatment 
will, in many cases, send the temperature back 



NURSING THE SICK CHILD 27 

to normal and avert an attack of more serious 
illness. A clinical thermometer will many times 
save a mother weeks of exhausting nursing. If 
the fever persists after twenty-four • hours, or 
if it is very high when you discover it, or shoots 
up rapidly in three or four hours, call your phy- 
sician without delay as something of a more 
serious nature is developing. The fever that 
comes on gradually, mounting higher each day 
is also a sign of serious illness. 

Finally let me impress upon you that careful 
nursing is intelligent care of detail, repeated with 
daily precision, and is the assistance that, more 
often than medicines, gives the sick child his best 
chance for successful and rapid recovery. 

RULES FOR CARE AND QUARANTINE IN CONTAGIOUS 

DISEASES 

The room to receive the isolated patient should 
be in the upper part of the house away from 
noise and disturbances. It should be properly 
lighted, ventilated and warmed and should be 
carefully screened from flies to prevent spread 
of the contagion. There should be an adjoining 
room where the trays can be brought, where the 
nurse can change her clothes and where per- 
sons who must speak to the nurse may come 
without entering the sick-room. If possible a 
bath-room should adjoin. 

Any other doors than the one leading to the 



28 DISEASES OF INFANCY 

ante-room should be locked and the cracks stuffed 
with paper or cotton. The door from the ante- 
room into the hall should be kept closed and a 
sheet hung there kept moistened with a solution 
of corrosive sublimate (1:1000) or a solution of 
carbolic acid (5%). 

The windows in the ante-room, weather per- 
mitting, should be kept open, thus separating the 
quarantined room and the rest of the house by 
a current of fresh air. The sick-room should 
be properly ventilated and stripped of unnec- 
essary furnishings as previously described in 
this chapter. Strict cleanliness should be 
observed, all dust being wiped from floors and 
other woodwork with a solution of bichloride, 
1:1000 (this should not be used on metal). 

Food for nurse and patient should be brought 
to the door of the ante-room. Dishes, spoons 
and other articles used should be disinfected by 
boiling or washed in a five per cent solution of 
carbolic acid in which they should lie for half 
an hour. 

Bed and body clothing should be frequently 
changed and disinfected in the ante-room by 
being immersed in a five per cent solution of 
carbolic acid or a 1:1000 solution of corrosive 
sublimate. After thorough soaking they should 
be wrung out, placed in a receptacle and handed 
by the nurse to an attendant at the door of the 
ante-room. They can then be laundered with- 



NURSING THE SICK CHILD 29 

out danger. Old bits of linen and absorbent 
cotton should replace handkerchiefs and be 
destroyed by burning. 

All discharge from eyes, nose, mouth, and in 
the case of typhoid fever, from intestine and 
bladder, must be disinfected or destroyed 
promptly and with utmost care. When there is 
much expectoration, paper sputum-cups can be 
used and burned. 

The dress of the nurse should be washable 
and the hair should be entirely covered by a cap. 
She should have her meals in the sick-room or 
in the ante-room, and leave these rooms only 
when going directly outdoors. Before leaving 
the house she should remove her sick-room gar- 
ments and disinfect her hands and face with a 
two per cent solution of carbolic acid or a 1 :5000 
of corrosive sublimate. Her street clothes should 
be kept in the ante-room and she should go 
directly out without stopping to talk to others 
in the house. Those of the family who enter 
the sick-room to relieve the nurse must use the 
same care. A linen coat and cap for the physi- 
cian should be kept in the ante-rootn for the same 
purpose. 

Any members of the quarantined family who 
are not immune to the disease and who have to 
mingle with others should if possible be removed 
from the house before there is any liability of 
the disease entering their systems, otherwise they 



30 DISEASES OF INFANCY 

should be kept from school or association with 
others until the quarantine is lifted. When the 
disease is over the patient should receive a dis- 
infecting bath which consists of a two per cent 
solution of carbolic acid for children over three 
years, and a one per cent solution for younger 
children. The hair should be thoroughly sham- 
pooed. Clean clothing should be put on and the 
child removed to another room. The sick-room 
and all that is in it should be thoroughly dis- 
infected and then exposed to the open air and 
sunlight for a number of days. All woodwork 
and painted walls should be scrubbed and washed 
with the solution of corrosive sublimate (1:1000). 
Kalsomined walls should be rekalsomined and 
the paper should be removed from papered walls. 
Metal is disinfected by washing with a five per 
cent solution of carbolic acid. . The sick-room 
should be fumigated for twelve hours, cracks in 
doors and windows being stopped up with cotton, 
by burning a formaldehyde lamp or candle. All 
toys and books used by the child during illness 
should be burned. All clothing worn by the 
child when taken sick (that cannot be put in boil- 
ing water) should be immediately hung in the 
fresh air and sunlight for several days. 

CARE OF THE CHILD DURING CONVALESCENCE 

The care of the child during convalescene is 
just as important as during the acute stage of 



NURSING THE SICK CHILD 31 

illness. Much irreparable harm is done by the 
neglect of this important period. The system 
of the child is more nervously and physically 
exhausted by illness than that of the adult, the 
diet has been restricted, the high temperature has 
burned up much of the body tissue, and as a con- 
sequence nutrition is greatly lowered. If the dis- 
ease is of an infectious origin or is prolonged the 
blood may be greatly impoverished and the child 
become anaemic. The heart of a child is especially 
susceptible to the poisons of an infectious disease 
or any disease of a bacterial nature ; the nervous 
system is far more sensitive than that ot' an 
adult and the ordeal of an acute illness often 
leaves a child very nervous and easily disturbed. 

One of the most unfortunate mistakes com- 
monly made is to relax all care as soon as the 
acute stage of illness is over and permit again 
the routine of daily life without a sufficient inter- 
vening period of rest and building-up. This mis- 
take is very often made after operations. There 
seems to be an impression in the minds of many 
that the more quickly a child can be gotten up 
out of bed the more brilliant can the operation 
be called. 

The child who undergoes an operation and 
takes a general anesthetic experiences a consid- 
erable shock to the system and even though he is 
put to sleep during the operation much vital 
force is lost. After an operation for the removal 



32 DISEASES OF INFANCY 

of tonsils, for example, a child is often allowed 
out of bed the following day. The results of 
such an operation are far more satisfactory and 
the child's health materially benefited when a 
rest in bed of at least one week is insisted 
upon. 

In convalescing from any acute illness the 
period of rest must be long enough for the heart 
to regain its normal strength. Many children 
are made invalids for life by running about as 
usual while the heart is still weak. The child 
should be kept quiet in the open air, weather 
permitting, until your physician finds the pulse 
and heart action normal. This may tax all your 
ingenuity because of the child's eager desire to 
rejoin his playmates, but his entire future health 
depends upon the few extra days or weeks of rest 
at such a critical time. 

After an acute illness the child often has an 
unusual appetite, but the digestion is weak and 
must not be overtaxed. Other children have 
little or no appetite and every means must be 
used, even bribing, to induce the eating of nour- 
ishing foods. Meat, cooked until tender, must 
be given in very small portions at first; eggs 
should be poached or boiled, never fried ; custards 
and junket; milk and well-cooked cereal, espe- 
cially oatmeal cooked three hours, should be 
eaten liberally. The juices of fresh fruits are 
ideal for the convalescing child, also all well- 



NURSING THE SICK CHILD 33 

cooked vegetables. Navy beans and raw vege- 
tables should not be given. 

Meals must be regular, allowing the stomach 
time for rest and small portions should be given 
at first. Indigestion invariably follows the prac- 
tice of giving four or five meals a day. If a 
child gets hungry between meals, he should have 
no more than a glass of milk or piece of toast 
or well-baked whole-wheat bread and butter 
(never fresh bread). "Water must be urged upon 
the convalescing child; four glasses should be 
taken daily between meals. 

The impoverished condition of the blood which 
follows practically all acute illnesses demands 
an iron tonic but this will be valueless without 
regularity of meals, proper diet, rest and fresh 
air. Your physician should prescribe the correct 
preparation of iron to meet your child's needs. 
Tincture of the chloride of iron and iron in the 
form of Blaud's pills are used very successfully 
for older children; in younger children, the 
citrate of iron and quinine, given in doses of one- 
half to one grain, put up in powders with the 
sugar of milk, dissolved in a little peach or 
orange juice and given just before meals. 

A good preparation of cod liver oil; one-half 
teaspoonful for younger children; one teaspoon- 
ful for older children, given immediately after 
meals, will help to build up the strength and 
nutrition. 



34 DISEASES OF INFANCY 

After illness children are nervous and fidgety. 
The nervous system has been swamped with the 
poisons, is weak and unstrung and the child does 
not get his balance until there has been a good 
period of rest and the general nutrition and 
condition of the blood have been restored. These 
nervous children need quiet, calm management 
and should be kept away from those not having 
a quieting influence. When the child begins to 
exercise and play, the mother must allow only 
a limited amount at first, insisting upon several 
periods of rest during the day, and a nap of 
one or two hours after the midday meal. 



CHAPTEE II 
MALNUTRITION 

The improperly nourished child is the child 
of low vitality, most susceptible to disease and 
least able to combat it. On healthy, well-nour- 
ished tissues, harmful bacteria find great diffi- 
culty in getting a foothold. Thus many children 
are victims of diseases merely because they are 
under-nourished. 

They are often given drugs and tonics over a 
long period of time when the disease might be 
overcome by proper food, rest and hygiene. The 
mal-nourished child is usually pale, tired, nerv- 
ous and below weight; often a restless sleeper; 
with a variable and uncertain appetite so often 
eating only certain fancied foods which are not 
the most suitable or nourishing ones. And 
because this child has not the strength and vital- 
ity of his healthy playmates, in trying to keep up 
with them in school or in play, the energy is over- 
taxed, the little reserve force is kept constantly 
depleted, and normal growth and nutrition are 
impossible. 

A child who has proper food, rest and fresh 

35 



36 DISEASES OF INFANCY 

air may remain malnourished because of some 
hidden condition which defeats all the efforts 
at correct feeding and hygiene. Chronically 
infected tonsils or enlarged adenoids ; decayed or 
infected teeth; an unsuspected tubercular infec- 
tion; an inherited blood disease; an infection 
with pus, in the pelvis of the kidney or in the 
bladder; or an undiscovered infection in any 
part of the body — any one of these conditions 
in a child would explain the presence of mal- 
nutrition. 

In all malnourished children, whether the fault 
is from improper feeding or hygiene or from 
hidden disease, there exists as a result of this 
an impoverished condition of the vital fluid, the 
blood, known medically as anemia. 

With a baby errors in feeding speedily result 
in malnutrition of an alarming type and over- 
feeding is just as common a cause as under- 
feeding. Too frequent feedings and irregular 
feedings disturb digestion and prevent proper 
nutrition. Artificial feeding always embraces 
the danger of too much fat or cream in the milk 
or too much sugar added to it. These errors 
are responsible for wrecking the digestion and 
exhausting the vitality of thousands of bottle-fed 
babies. 

Allowed solid foods and unsuitable foods from 
the table of the grown-up, long before his diges- 
tion is able to handle it, the baby and young 



MALNUTRITION 37 

child with repeated attacks of indigestion and 
diarrhea soon become victims of serious mal- 
nutrition. 

Even with adequate feeding, the baby denied 
the proper amount of fresh air and quiet, will 
not thrive, but will remain pale and weak 

Constipation allowed to persist has just as 
serious an influence upon the child's nutrition 
as it has upon the adult's. All these important 
details are taken up at length in the volume of 
this series entitled: The Proper Feeding of 
Infants. 

When a child remains malnourished in spite of 
proper feeding and hygiene, the physician will 
have to make a most thorough study of the 
physical condition, and this cannot be done in a 
few moments or a few hours. The tonsils and 
adenoids must be carefully examined ; if enlarged 
or infected they must be removed. The teeth 
must be put in order. Inflammed and sore gums 
must be properly treated. The blood must be 
studiously examined for anemia or the presence 
of an actual active infection circulating in it. 
It must be studied to see if an increase of the 
white cells shows the presence of infection in 
some organ of the body, and that infection must 
be sought and found. The von Pirquet skin 
test for tuberculosis, which is of such decisive 
value in children, should be carefully made. The 
urine should be examined for the presence of 



38 DISEASES OF INFANCY 

pus to see whether any infection exists in the 
bladder or in the pelvis of the kidneys. The 
eyes must not be overlooked, for eye-strain in 
the school child can throw the nervous system so 
out of balance as to seriously impair nutrition. 

After we pass the first year, there are many 
problems of the child's nutrition to be consid- 
ered. We have the child who suffers from an 
habitually poor appetite, who is with difficulty 
induced to take the proper amount or variety 
of foods. This child may drink several glasses 
of milk a day and take very little other food, and 
while milk is one of the best foods for growth, 
if the child at the run-about age takes it to the 
exclusion of other necessary foods, his nourish- 
ment suffers, he will become pale and under- 
weight, losing his appetite for the other essen- 
tial articles of diet. From the fifteenth month to 
the second year there should be no more than 
four regular meals a day. After the second year 
the child will do better on three regular meals. 

An error in the feeding of older children is to 
allow sweets, sugar, especially candy, in exces- 
sive amounts at mealtime or between meals. 
Sugar must be allowed only at mealtime and in 
moderate amounts. When candy is given, one 
piece with the meal or immediately after is suffi- 
cient. We have abundant proof that too much 
sugar and candy is responsible for serious types 
of digestive troubles. 



MALNUTRITION 39 

Young growing children should have their 
meals at their own table and should not sit with 
grown-ups where foods unsuitable for their diges- 
tion are served. Children clamor for these more 
undigestible foods and they are often given. The 
suitable foods which have been prepared espe- 
cially for them and the only foods on which they 
can properly grow and thrive, will then be 
refused. Repeated experiments have proven that 
children who have refused to eat the proper foods 
at their own tables, when put with other chil- 
dren at a children's table with these same foods 
before them have quickly learned to eat them 
with a relish. 

The undernourished child is the one who is 
always burning up his energy with too much 
study, play and exercise. The body has no 
opportunity to build up a reserve and as a 
natural result growth is hindered. The child 
who is daily overtired loses his appetite and 
becomes the notional, finical eater. Because the 
child is a little bit sickly and underweight and 
below par he is oftentimes indulged in the mat- 
ter of food. Because he does not eat much at 
mealtime he is given food at irregular hours, 
generally sweets; the digestion becomes weaker 
and weaker, and the natural appetite for whole- 
some food is ruined. 

Malnourished children are also commonly the 
ones who are not receiving, especially while 



40 DISEASES OF INFANCY 

sleeping, the proper amount of fresh air, without 
which, food, no matter how suitable or nourish- 
ing, cannot be converted into blood, bone and 
tissue. 

THE CORRECTION 

To begin with, if the child of the run-about 
age has been drinking more than three or four 
cups of milk a day and eating little or none of 
the cereals, vegetables, bread and butter, eggs, 
meat broths and meat, cooked fruits and fruit 
juices; then the milk must be limited and these 
other necessary nourishing foods must be added 
to the daily diet in the proper variety. Where 
the appetite is very poor it will be wise to with- 
draw milk from the diet entirely for three or 
four days. For three or four days put the child 
on a diet of strained vegetable soup, chicken 
broth, stewed fruit and thin cereal gruel. This 
limited diet, the withdrawal of milk and meals 
at the regular mealtime will in nearly all cases 
result in a sharpened appetite for a variety of 
foods. 

As soon as the child has started to eat with 
some relish, again add milk to the diet, starting 
at first with one cup a day of skimmed milk, 
increase to two cups a day taken with the meals, 
then to three. If this does not interfere with 
the appetite for the other foods you can then 
give three cups of whole milk daily, feeding the 



MALNUTRITION 41 

three cups with the three meals given at regular 
hours. 

All these malnourished children need more 
fat ; get them to eat cereals with sugar and butter 
instead of milk, put lots of butter on bread and 
other foods. Give a teaspoonful of olive oil with 
each meal or right after it. Children take it 
well. 

The natural cereals, such as oatmeal and 
cracked oats or Cream of Wheat, cooked for three 
hours, contain splendid nourishment for the grow- 
ing child. Whole-wheat bread, well baked pota- 
toes, spinach, asparagus, carrots, turnips, peas, 
etc., the vegetables well-cooked (and mashed for 
the younger child) should be given. Eggs should 
be poached or soft-boiled, not fried, and given 
once a day. Before the fifth year red meat had 
better be given only three ' times a week and 
meat soups not on the same day with meat. Give 
lamb and chicken broth on alternate days, or a 
little chopped chicken or turkey. Give fruit 
juice and the desirable stewed fruits at least once 
a day. Give one cup of milk with each meal 
except when temporarily removed. For des- 
sert use plain puddings or ice-cream made from 
milk, not cream, once or twice a week. The 
active rapidly growing child may need some- 
thing to eat between dinner and supper, and if 
this is found not to interfere with the appetite 
for supper, an apple, pear or other suitable fruit 



42 DISEASES OF INFANCY 

with a graham or oatmeal cracker, or a piece 
of two-day-old bread and butter should be given, 
never cake or other sweets. 

With the beginning of the school-age a larger 
variety of foods can be introduced. Strictly 
avoid fried foods, pastry, pie, doughnuts, fresh 
bread, rich gravies, sauces and highly seasoned 
dishes, also coffee and tea. Salads with plain 
dressings can be given and nearly all the well- 
ripened fruits. Give the school-child three meals 
a day and at regular hours. 

The pale, under-nourished child should be kept 
out of school. His energy should be conserved 
at all times ; he should be put to bed regularly at 
eight o 'clock and have at least twelve hours ' sleep 
every night. One window at least in the sleep- 
ing room should be open summer and winter. 
After the midday meal he should take off all- 
clothing and go to bed in a quiet room with the 
window open, sleeping, if possible, for two hours. 
With this careful regime if the child still remains 
malnourished the physician should make all the 
careful examinations that have been suggested 
to discover the hidden cause for the malnutri- 
tion. 

Children who do not improve rapidly are many 
times helped by the use of iron tonics. Children 
between the third and fifth years take the citrate 
of iron and quinine. One grain is put up in a 
powder with sugar of milk, one powder is dis- 



MALNUTRITION 43 

solved in a little peach or orange juice or a tea- 
spoonful of milk and taken before each meal. 
Younger children will take one-half grain in the 
same way. For older children there are many 
different preparations of iron which can "be pre- 
scribed by your physician, such as Blaud's Pill, 
one after each meal. There are times when 
arsenic is needed. This can be given in the form 
of Fowler's Solution, but must be prescribed by 
your physician to meet the requirements of the 
individual case. It is usually necessary to take 
the iron for several weeks before good results 
are noticed. Cod-liver oil given alone or with 
the iron is always an aid in bringing up the 
weight and general nutrition. 

If stubborn constipation persists obtain one of 
the mineral oils, such as liquid albolene, Nu-jol 
or Interol, and give enough at night to cause 
one good bowel movement each day; one, two or 
even three teaspoonfuls may be necessary. 
(These oils can be given over an extended period 
and are not at all harmful as are the habit-form- 
ing cathartics). 



CHAPTEE III 
DIPHTHERIA 

Whenever a child complains of not feeling well 
take him at once to the light, hold the tongue 
down (use the handle of a spoon) and carefully 
examine the mouth and throat. This is a wise 
practice; it familiarizes the mother with the 
normal appearance of her child's throat and 
enables her to detect the first signs of inflamma- 
tion or disease of the throat and tonsils. 

Diphtheria is an infectious disease caused by 
a distinct germ which locates in the lining of the 
nose and throat and develops a membrane-like 
coating. The germ is generally transmitted by 
a person suffering from the disease or con- 
valescing, or by a third person who is a "car- 
rier. " It is also communicated through infected 
milk and occasionally by domestic animals, books, 
toys and other objects on which the germs have 
lodged, and these germs remain active for some 
time. Many healthy adults and children carry 
diphtheria germs in their throats for months 
without themselves developing the disease 
because some natural antitoxin in their blood ren- 

44 



DIPHTHERIA 45 

ders them immune although they readily transfer 
it to others who are not immune. About fifty 
per cent of all children from the ages of one to 
fifteen years are naturally immune to diphtheria. 

Susceptibility to the disease increases with 
cold weather because of the indoor life, closer 
housing, poorer ventilation and constant con- 
tact of many children in schools, which impairs 
resistance, and the greater danger of direct con- 
tact with "carriers" of diphtheria germs. Infec- 
tions of the nose and throat with soreness and 
inflammation, which prevail during the winter, 
make the contraction of diphtheria more liable. 

Immunity to diphtheria can be shown by the 
Schick test which should be made whenever there 
is an outbreak of the disease and children or 
adults who are not immune should be given anti- 
diphtheria serum to protect them from an attack. 

Diphtheria does not come on suddenly with 
immediate acute and violent sickness, as many 
mothers suppose, but manifests itself gradually 
for two to ten days after exposure. The child 
becomes listless, fretful or irritable, or will seem 
dull and a little pale. He may or may not com- 
plain of sore throat and headache. There may 
be vomiting, loss of appetite or a chill and a 
fever of one or two degrees. A common symptom 
is swelling of the glands down each side of the 
neck, with difficulty in swallowing and pains in 
the throat. The latter are less severe in some 



46 DISEASES OF INFANCY 

children and do not always indicate the acute- 
ness of the inflammation. The child usually goes 
to school for two or three days, feeling not quite 
himself and complaining a little before he 
becomes real sick. 

The practice of examining the throat at the 
first sign of something wrong will disclose to the 
mother the first spots of diphtheria, th< 
" patches" of white, yellow or greyish white 
varying in size from a pinhead to a mass cover- 
ing the throat, but which usually form first in 
very small spots on the tonsils and from there 
spread to the roof of the mouth, the soft palate 
and the back of the throat. Such an examination 
should be made when in any doubt. 

In some cases these spots or "patches" first 
appear in the nasal cavity and are not visible, 
but there is nearly always a suspicious foul 
breath and a discharge from the nose. This dis- 
charge may come from one nostril only and be 
tinged with blood and so irritating as to burn 
the skin of the upper lip. 

In other cases the membrane of diphtheria may 
form low down in the throat, in the larynx and 
is commonly called membranous croup. This is 
laryngeal diphtheria and the symptoms are some- 
what different from those just described. The 
membrane may fill up the throat so rapidly as 
to interfere with breathing, causing the child 
to become blue in the face and to struggle so 






DIPHTHERIA 47 

desperately for breath that it can be heard all 
over the house. 

This difficulty in breathing in laryngeal diph- 
theria may lead the mother to think the child 
has croup but she can distinguish between the 
two conditions by the following differences. 
Ordinary croup usually attacks the child sud- 
denly; diphtheria croup comes on gradually as 
a rule with the child ailing for several days, and 
sometimes the "patches" are visible in the throat 
before they extend downward. In croup, which 
usually comes on at night, the difficulty in breath- 
ing comes suddenly. In diphtheritic croup there 
is hparsenesse at first and the difficulty in breath- 
ing comes on gradually during the day or night. 
In croup the difficulty is in breathing in, the 
breath being expelled without trouble. In diph- 
theritic croup, where the membrane low down in 
the throat obstructs breathng, the child has as 
much difficulty breathing out as in breathing in. 

In this type of diphtheria, if the anti-toxin 
has not been given early enough, the throat may 
so completely fill with the membrane that a tube 
must be inserted in the wind-pipe by your phy- 
sician to prevent the child from strangling to 
death. This is called intubation. 

The character of the membrane forming in 
the "patches" or spots on the tonsils and other 
parts of the throat may be very confusing, often 
presenting the appearance of a simple case of 



48 DISEASES OF INFANCY 

follicular tonsillitis. In the latter the spots are 
generally small and separated, while in diph- 
theria they tend to run together, forming finally 
in one large membrane which may change from 
white or yellowish-white to a dirty grey and 
in severe cases to a blackish color. As this is 
not always true, a laboratory examination must 
be made and the physician will take a swab from 
the throat. But as this examination takes sev- 
eral hours and much valuable time is thus lost 
in waiting for a report, if there is the slightest 
question in your physician's mind he will not 
hesitate to give the child a good sized dose of 
diphtheritic antitoxin at once. 

ANTITOXIN 

The value of antitoxin consists in giving it 
as soon as possible after the infection has got- 
ten into the throat. A delay of two days is 
often fatal and experience has shown that a 
delay of three days greatly diminishes the 
chances of saving the patient* It is a wise plan 
to give a good large dose in the very beginning. 
This is injected under the skin into the muscles. 
Whenever the membrane is spreading down into 
the throat and interfering with breathing, the 
use of the large dose is imperative and if decided 
improvement is not shown in six to twelve hours 
it should be repeated if your physician deems it 
wise. When antitoxin is given early and in suf- 



Hn f » 



I " <; i|<: 




S I J 




JL, 






Top — Follicular Tonsillitis. A— Soft Palate. B— Uvula. C- 
Tonsils with Small White Patches. Lower — Diphtheria. 
D — Diphtheritic Membrane Covering Tonsils. 



DIPHTHERIA 49 

ficient dosage the membrane begins to clear from 
the throat rapidly and may be gone entirely by 
the fourth or fifth day and nearly always by the 
end of the week. Given early it is the one chance 
of saving the child and even though there has 
been a delay and the child is desperately sick 
the antitoxin should be injected though its value 
is not so great as when given on the first or 
second day after the appearance of the 
"patches.-" In very desperate cases it has turned 
the tide to recovery. Antitoxin has no effect 
upon the tissues that have been seriously dam- 
aged by the poisons of diphtheria. If nerves 
have become paralyzed, the heart weak and kid- 
neys affected, the antitoxin does not help them 
back to health but it prevents the spread of the 
disease in the throat, and when given early 
saves the lives of most patients. 

Diphtheritic antitoxin comes put up in syringes 
ready for injection; the doses are measured by 
units ; physicians do not hesitate to give children 
over two years of age, 3,000, 4,000 or even 5,000 
units, and babies 1,000 or 2,000 units. It is our 
most reliable preventive of diphtheria and when- 
ever the disease breaks out in a home, if the 
rest of the family cannot avail themselves of the 
Schick test to determine whether or not they are 
immune to the disease, the physician gives what 
is called an immunizing dose of the antitoxin 
(500 to 1,000 units) to each member of the fam- 



50 DISEASES OF INFANCY 

ily. The antitoxin is not necessary where the 
Schick test shows the adult or child is immune. 

Only rarely do there develop unfavorable 
symptoms after an injection of antitoxin. A 
rash as in scarlet fever may break out or the 
body may be covered with hives. Vomiting, 
severe headache or great exhaustion may occur, 
all to disappear within a few days. The itching 
of the rash may be very uncomfortable while it 
lasts, but sponging with water in which is put 
a few drops of carbolic acid will relieve this 
irritation. Should antitoxin make a child ill 
it is important to remember the occurrence and 
advise your physician of it in case of another 
outbreak or an attack of diphtheria so that he 
may be guided in its use in injecting it a second 
time. This is important. 

Diphtheria is serious, not alone because of the 
formation of the membrane in the throat from 
which the child may strangle, but also because 
of the poisons thrown into the blood by the 
bacilli of the disease. These circulate to every 
part of the body and their effect may be most 
serious, especially to the heart, causing the 
muscles of the heart to become weak and flabby. 

These poisons may quickly affect the kidneys, 
causing symptoms of Bright 's disease. One of 
the most serious consequences is a total paralysis 
of many of the nerves. The soft palate is most 
commonly affected and when this is paralyzed 



DIPHTHERIA 51 

fluids pass up into the nose instead of into the 
throat. Because of paralysis of the nerves con- 
trolling the act of swallowing, this may be 
greatly interfered with. In many cases the 
muscles of the eyes are left temporarily weak, 
one eye turning sharply in or out after an attack 
of diphtheria ; sometimes - both eyes are left 
crossed. The muscles of the face or limbs may 
be affected for a few weeks but all traces of 
diphtheritic paralysis usually disappear in a 
short time. 

THE TREATMENT 

The child must be isolated and quarantine 
established as soon as you find that the throat 
looks suspicious. For the sick-room select one 
that receives lots of sunshine and fresh air and 
follow the general rules laid down for use in 
cases of contagious diseases, in the first chapter. 

In cold weather the heat should be turned on 
in the room but plenty of fresh air must be 
admitted constantly day and night. If possible, 
send the other members of the family away from 
the house during the attack; in all events they 
should receive an immunizing dose of serum. 

Those caring for the sick child must protect 
themselves by the use of antiseptic gargles and 
sprays used every two or three hours. Use a 
weak solution of carbolic acid or Dobell's solu- 
tion for gargle and spray. 



52 DISEASES OF INFANCY 

A wash dress must be slipped over the clothes 
of the mother or other attendant on entering 
the sick room and taken off on leaving it. All 
books and toys used by the child during the ill- 
ness must be burned and all other routine for 
the sick-room laid down in the first chapter in 
the care of contagious diseases must be rigidly 
followed. 

The diet in diphtheria is one of the perplexing 
problems because the membrane in the throat so 
greatly interferes with swallowing. The baby 
is often unable to nurse and must be fed from 
a spoon the milk pumped from the breast. He 
should receive only half the usual nursing, the 
full amount being made up by adding water. The 
bottle baby's milk should be diluted with water 
in the same manner. Older children will usually 
take milk, clear broths and strained vegetable 
soup very well. Children who have an aversion 
to milk will take thin gruels. As the throat 
improves, a little cold junket and bustard can 
be added. Water should be given freely. Your 
physician will see that the bowels are kept well 
open so that no poisons will accumulate in the 
intestines. 

Other treatment than the use of antitoxin is 
largely a cleansing measure and has little effect 
in actually destroying the poisons of the diph- 
theria germs. Irrigating the throat every three 
hours with the normal salt solution, as described 



DIPHTHERIA 53 

under Tonsillitis, helps cleanse the throat, relieve 
the pain and may make breathing easier. If 
the child struggles violently and resists the treat- 
ment it can do more harm than good. Spraying 
the nose with DobelPs Solution gives relief and 
in young children where mucous accumulates in 
the nose, one or two drops of liquid albolene 
put in each nostril every hour makes breathing 
easier. 

Quarantine must be rigidly preserved until two 
bacteriological tests show that no bacilli are 
present in the throat. It takes from one to two 
weeks to clear the throat and in some cases 
longer. If you live where examinations cannot 
be made, you should keep your child in quaran- 
tine for three weeks. 

When throat cultures show that a child is a 
" carrier' ' of diphtheria I believe the child should 
be kept out of school and the throat and nose 
sprayed and gargled with DobelPs or a normal 
salt solution until the germs have been destroyed 
and the bacteriological test shows this. 

The care of the child during convalescence is 
extremely important. The heart is greatly weak- 
ened by the poisons of diphtheria, the kidneys 
may also be affected and the general resistance 
'is lowered. Early in the attack your physician 
will keep careful watch of the kidneys by fre- 
quent examinations of the urine and will give 
the child something to support the heart. Exper- 



54 DISEASES OF INFANCY 

ience has taught that small doses of brandy 
during the height of the attack are very valuable 
for this purpose. 

Insist upon rest and quiet for your child for 
a long time after an attack of diphtheria to 
enable the heart to recover. After quarantine get 
the child outdoors as soon as possible, even in 
cold weather, well bundled up, in a reclining or 
partly reclining position. The child is left pale 
and anaemic by the attack and iron tonics should 
be given. Even during the illness the tincture of 
the chloride of iron is very valuable and can be 
kept up for a long time afterward. Good nourish- 
ing foods should be given if your physician finds 
that the kidneys are doing their work all right. 
Guard the child zealously from hard play and 
strenuous exercise for many weeks after he is up 
and about until the heart gets strong again. 



CHAPTER IV 
SCARLET FEVER 

Scarlet fever, or scarlatina as it is also called, 
is less contagious than the other infectious dis- 
eases of childhood. It can be communicated 
from the earliest stage, before the rash appears, 
and is thus commonly spread by school children 
who are coming down with the disease. Children 
between the ages of five and ten are most sus- 
ceptible, babies are rarely infected and many 
children and adults seem entirely immune, not 
contracting the disease even when brought in 
closest contact with it. 

Scarlet fever is most commonly spread by 
direct contact with the discharge from nose or 
throat of the patient, although it may be* con- 
veyed by any article of clothing, furniture or by 
a third person who has been in contact with 
a scarlet fever patient. It is sometimes carried 
in the milk from persons in a dairy who have 
been exposed to the disease. 

The characteristic symptoms of this disease 
are high fever, sore throat and a red rash first 
seen on the neck, chest, arms and hands and 

55 



j 6 DISEASES OF INFANCY 

which quickly spreads all over the body in tiny 
red spots so closely crowded together that they 
look like one mass of scarlet. Sometimes these 
red spots are pimple-like and contain fluid. 

The period of incubation (this is the time that 
elapses between the exposure and the first symp- 
toms) is generally less than a week and may be 
as short as one or two days. The fever comes 
on suddenly and sharply. There may be chills, 
vomiting, and painfully sore throat. The tem- 
perature rises rapidly to 102° or 103° F., with 
a decided increase in the pulse. In some cases, 
notably in younger children, the attack begins 
with convulsions. These symptoms generally 
continue for twenty-four hours' before the rash 
makes its appearance, although the child may be 
taken ill at night and be broken out next morn- 
ing with a well developed eruption. The rash 
commonly takes forty-eight hours to come out, 
then begins to fade and has disappeared within 
a week. The disease is as a rule more severe 
as the rash is more brightly scarlet, although 
in one of the most severe types of scarlet fever 
there is little or no eruption. The tongue in the 
beginning is coated, but about the fourth day 
sheds much of this and discloses tiny red spots 
which gives the name of " strawberry" tongue, tf 
The entire throat, soft palate and tonsils are 
red and swollen, giving off considerable mucous 
and it is this mucous with the discharge from 



SCARLET FEVER 57 

the nose and ears which is so contagious. The 
glands at the angles of the jaw are always swol- 
len in scarlet fever and the glands down the 
neck on both sides generally are very tender and 
swollen. They may swell so greatly that they 
have to be opened so that the pus may be 
discharged. 

In the usual case of scarlet fever the fever 
subsides as the eruption disappears and the peel- 
ing process begins, this peeling starting as the 
rash began and spreading over the body. The 
skin comes off in fine flaky scales, except where 
it is thick over the palms of the hands and soles 
of the feet where it comes off in large pieces. 
The entire skin of a finger or toe may peel off 
at once like the finger of a glove. This peeling 
process takes six to eight weeks, sometimes 
longer, and during this stage the patient must 
be carefully tended as it is at this time that 
complications are apt to develop. 

There are three types of scarlet fever, the 
simple ; the more severe ; and the malignant. In 
the simple type, the fever and rash are slight, 
often scarcely noticeable although the child may 
later suffer from some of the complications' of 
the disease. 

In the more severe type the throat is intensely 
sore and inflammed while the rash may not be so 
marked and may develop and subside more slowly 
than in Jthe simple type. Membranous patches 



58 DISEASES OF INFANCY 

similar to those of diphtheria may appear in the 
throat and it is in this type that the glands of 
the neck may become so swollen as to develop 
abscesses. Because the throat is so swollen 
there is great difficulty in moving the jaw. 
There will be a discharge from the nose which, 
much like the discharge in nasal diphtheria, 
excoriates the skin of the upper lip. The child 
looks very ill, the face is white and pinched with 
a waxy appearance. There is great exhaustion 
and profuse sweating with oftentimes delirium, 
and the child will talk irrationally and lie in 
a partial stupor. In this type the kidneys are 
nearly always affected, showing unmistakable 
signs of acute Bright ? s disease. 

In malignant scarlet fever the poisoning is 
more intense and may prove fatal in the first 
few hours or days of the disease, even before 
the rash has appeared. When the rash does 
appear, instead of being scarlet it is an intense 
dusky livid red. This rash may suddenly fade 
and the child go into convulsions which are very 
liable to prove rapidly fatal. 

The most serious thing the mother and phy- 
sician have to contend with in scarlet fever is 
the danger of complications which so often occur. 
The most serious is inflammation of the kidneys 
which manifests itself as Bright ? s disease and 
must be guarded against throughout the whole 
course of the fever and especially during the 



SCARLET FEVER 59 

peeling stages and convalescence. This inflam- 
mation is accompanied by pain in the loins, vom- 
iting and fever, as a rule, but may develop 
without these signs. The symptom practically 
always present in Bright 's disease developing 
during scarlet fever is the swelling of the face 
and eyelids giving a puffy appearance. 

During the course of the fever and convales- 
cence the physician will make repeated exam- 
inations of the urine to keep accurately informed 
as to the condition of the kidneys. When inflam- 
mation and symptoms of Bright 's disease 
develop, the urine becomes scanty and high 
colored, often containing blood, and a laboratory, 
analysis will show the presence of much albumin. 
It is important that this condition be determined 
and carefully treated, otherwise it may result 
in permanent injury to the kidneys with chronic 
Bright 's disease. 

The next important complication is inflamma- 
tion of the middle ear caused by the infection 
from the throat extending up through the eus- 
tachian tube where it produces a violent and 
extremely painful inflammation with pus behind 
or back of the ear-drum which must be opened 
by the physician in order to allow the pus to 
escape. If this is not done the pus accumulates 
in quantities and forcibly ruptures through the 
ear-drum, often resulting in serious impairment 
of hearing and at times actual deafness. If 



60 DISEASES OF INFANCY 

the ear-drum is opened and the pus allowed to 
escape before violently tearing through the drum, 
much of this danger is averted. Another grave 
danger of allowing the pus to remain until the 
drum ruptures is the possibility of its extending 
backward into the mastoid cells back of the ear, 
setting up that most serious and dangerous com- 
plication, acute mastoiditis, which necessitates 
a most serious operation. After the ear-drum 
has been opened and pus is discharging from 
the ear, the canal must be kept clean by careful 
syringing every three or four hours, with a sat- 
urated solution of boric acid, one teaspoonful to 
the pint of water, boiled five minutes and used 
warm. 

Another serious complication which may 
develop is rheumatism and it affects the joints. 
The treatment is the same as laid down in the 
chapter on Rheumatism. The heart may become 
affected during an attack of scarlet fever 
although this is rare, but during convalescence 
the child must be carefully watched to prevent 
over-exertion until the heart gets strong. 

THE TREATMENT 

The treatment for scarlet fever consists prin- 
cipally of careful nursing. Quarantine is the 
first requisite, the child should be isolated as soon 
as the disease is suspected, and this should last 
six weeks or longer if the desquamation (or 



SCARLET FEVER 61 

peeling) or the discharge from the ears or nose 
persist. The infection is apt to adhere to some 
of the peeling skin and is always dangerously 
alive in the discharges. The patient must be 
kept in bed to the end of the peeling stage and 
for three weeks at least even in mild cases. The 
disease must run its course, there is no method 
of shortening the attack. 

Until the temperature is normal the diet should 
be liquid ; milk is the best food ; thin cereal gruel 
is a substitute if milk is not well taken by the 
child. After the fever the diet should still con- 
sist of cereals and milk, meat and eggs not being 
given until after the third week. If the child 
will drink it, buttermilk is a splendid food to 
give, and Vichy or lithia water are valuable 
drinks during the fever and convalescence. 
Soups and animal foods should be avoided as 
they place too great a strain upon the kidneys. 
The drinking of lots of water is an important 
measure. Sucking small pieces of ice will relieve 
the extreme soreness of the throat. 

The daily warm bath is not only a cleansing 
measure but helps keep the skin active and 
relieves the kidneys of some of the work of excre- 
tion. Care should be taken to avoid chilling the 
skin because of its serious effect upon the kid- 
neys and also because these patients have a 
tendency to develop broncho-pneumonia. The 
bathing should be done under the bed-clothes 



62 DISEASES OF INFANCY 

and only a part of the body exposed at a time. 
The skin should be anointed with sweet oil, olive 
oil or liquid albolene to allay the itching. This 
also prevents the scales (which may have some 
of the infectious material from the nose and 
throat clinging to them) from flying about and 
becoming attached to various objects in the room 
and to the clothing that is carried out of the 
room, and further makes the peeling more rapid. 

The nose and throat should be sprayed with 
antiseptic solutions and the throat irrigated with 
the warm normal salt solution as recommended 
in acute tonsilitis. In severe cases a gargle of 
twenty drops of carbolic acid to a half glass 
of warm water should be employed or the throat 
should be swabed with an even stronger solution 
of carbolic acid (twenty-five drops in one-half 
glass of water) to relieve much of the pain and 
to aid in sterilizing the throat. A normal salt 
solution or Dobell's Solution can be used for 
spraying the nose. 

The temperature may become extremely high 
at times and the child sleepless and restless. 
This can be relieved by sponging with tepid 
water, using one-third alcohol. If the child bears 
this well the water can be used a little cooler 
at the next sponging or if the nervous symptoms 
return. The water must not be cool enough to 
make the child chilly or uncomfortable. 

Your physician will carefully watch the child 's 



SCARLET FEVER 63 

pulse and if it becomes weak and rapid, and the 
hands and feet become cold and turn bluish, he 
will promptly give a stimulant to support the 
action of the heart. To relieve the pain in the 
swollen glands in the neck, apply an ointment of 
ten or fifteen per cent of ichthyol over the glands 
and cover securely to prevent staining the bed- 
clothes, or use the ice-bag if this does not make 
the child chilly or uncomfortable. If pus forms 
in the glands and they have to be opened, 
the discharge is hastened by applying hot cloths 
wrung out of a saturated solution of boric acid. 

When inflammation of the kidneys develops, 
with signs of acute Bright 's disease; any chill- 
ing of the skin or draughts which must be avoided 
at all times during scarlet fever, are especially 
harmful. Over the region of the kidneys, towels 
wrung out of hot water or even the application 
of a mustard plaster to produce a vigorous red- 
ness of the skin are helpful. Your physician 
will prescribe some diuretic (stimulant) to keep 
the kidneys active. The diet will be limited to 
thin cereal gruels and milk. Warm sponging of 
the body is also an aid in this complication. 

Throughout the attack and convalescence the 
important thing is to keep the child in bed, cov- 
ered lightly but warmly at all times, and in a 
room that is so ventilated that fresh air is con- 
stantly supplied without the child/s being in a 
draught. 



64 DISEASES OP INFANCY 

Scarlet fever greatly lowers the vitality, 
strength returns slowly, the child will be anaemic 
and will need iron tonics, cod liver oil and good 
nourishing food. He should be out-doors as soon 
as the quarantine can safely be lifted, but kept 
quiet on the porch or in an airy room or sleep- 
ing-porch until his strength has been built up, 
until the physician has declared the heart to be 
strong and until much of the anaemia and weak- 
ness have disappeared. 






CHAPTER V 

MEASLES 

Measles is an infectious disease most common 
in children between seven and fourteen years of 
age. It is rare, but not unknown, in babies and 
in adults who have not had an attack in child- 
hood. The contagion is present in the skin and 
in the secretions from the nose and mouth and 
can be conveyed by these particles even when they 
have become dry and gotten on clothes, toys or 
other objects. The germs of measles do not live 
as long in this way, however, as the germs of 
scarlet fever or diphtheria. 

Measles may appear in a malignant form but 
the disease is usually mild 5 the risk being due 
to the complications which may arise, such as 
bronchitis, pneumonia and tuberculosis. Such 
complications are more to be feared in winter and 
with very delicate children. Inflammation of 
the throat, with croup symptoms; severe diar- 
rhea; persistent inflammation of the eyes; dis- 
charge from the ears (infection getting into the 
middle ear, causing pus) often resulting in par- 
tial deafness; are the other complications apt 

65 



66 DISEASES OF INFANCY 

to arise during a course of measles. In addition 
to the risk of these complications, measles has 
a tendency to leave the general health in a weak- 
ened state, rendering the child susceptible to 
throat and chest complaints, especially to bron- 
chitis and tuberculosis. Thus it is to be seen 
that while measles is regarded as a simple and 
mild disease of childhood, no other common ail- 
ment calls for more careful watching to prevent 
these attending dangers. 

Seven to fourteen days pass, with scarcely 
any disturbance of the health, before signs of 
measles appear after the contagion has entered 
the system, and the disease is most contagious 
one or two days before and for about three days 
after the eruption starts. The first symptoms 
are a sudden and acute catarrh of the mucous 
membranes, with sneezing, watery discharge from 
nose and eyes as in a cold, sometimes bleeding 
of the nose, and short frequent noisy coughing 
There is sometimes diarrhea and a feeling of 
sickness with dull eyes and lassitude, poor appe- 
tite and thirst occasioned by the fever, the tem- 
perature running 100° to 102° and sometimes 
two degrees higher with rapid pulse, headache 
and restlessness, as the eruption reaches its 
height. Very commonly these symptoms are 
slight, the child being scarcely ill so that he is 
not separated from his playmates during this 
most contagious stage of the disease. 



MEASLES 67 

In young children convulsions occasionally 
occur as the first symptoms of this stage of the 
disease, which lasts four or five days as a rule. 
On the fourth or fifth day (rarely later), after 
the first signs of fever, sneezing and cough; the 
measle rash appears, first on the brow, cheeks, 
chin, behind the ears and on the neck. It 
resembles slightly raised, dark-red flea bites, at 
first scattered and then appearing in irregular 
groups leaving crescent-like patches of clear skin 
between. The face becomes swollen and bloated, 
the rash spreads rapidly all over the body and 
remains at its height for two or three days, 
then fades as it began, from the face downwards, 
leaving scarcely a trace by the end of the week. 
The fever and catarrh, coated tongue, sore throat 
and other symptoms are aggravated when the 
rash begins to break out and this eruption some- 
times extends to the throat. Bluish-white points 
surrounded by small red areas on the lining of 
the lips and cheeks may precede this eruption. 
All these symptoms subside as the rash reaches 
its height, the temperature then drops and the 
crisis of the disease is passed. If none of the 
complications occur, the child generally feels well 
before the rash has entirely faded; then follows 
a slight peeling of the skin. 

The malignant type of measles which is rare, 
occurs generally in children who are below par 
because of lack of proper food, of cleanliness 



6S DISEASES OF INFANCY 

and of healthy surroundings. All the symptoms 
just described are severe, the rash shows* feebly, 
is of a dark purple color and the child is greatly 
prostrated. 

THE TKEATMENT 

The child should be isolated at the first symp- 
toms, such as the cough, fever, redness of the 
eyes and discharge from the nose. Measles is 
very contagious and it is because the child is 
commonly not quarantined until the rash breaks 
out that the disease is so frequently communi- 
cated. The quarantine should not be lifted for 
two weeks or longer if the discharge from nose 
and ears persists. Children who have been 
exposed should be kept from their playmates 
for fourteen days which is the extreme period 
the disease takes to develop. Measles is not 
very likely to be transmitted by a third person 
so that immune children (those who have had 
the disease) are of no danger to others. 

The precautions set forth in the first chapter 
for the management of contagious diseases and 
the sick-room should be followed. Susceptible 
children and adults of the family need not be 
sent from the house as they are not likely to 
become infected after the sick child has been 
isolated. 

The child should receive an abundance of fresh 
air but with careful guard against exposure, 



MEASLES 69 

because of the tendency to broncho-pneumonia. 
This is benefited by the fresh air treatment. 
Because of the catarrhal conditions, the tempera- 
ture of the room may be a little higher than 
for other contagious diseases but the air should 
be moist. A basin of fresh water should be kept 
on the steam-pipes or near the heater. While 
it is of advantage to keep the room sunny, the 
eyes should be carefully shielded by a screen. 

The child should be kept in bed, lightly cov- 
ered, while the fever lasts, and should be isolated 
for a week or perferably ten days in summer 
and for a longer time in winter. The head 
should be raised slightly, which tends to decrease 
the cough. There should be a light, nourishing 
liquid diet of milk, gruel and broths with a con- 
stant supply of drinking water. Oatmeal and 
foods that might excite diarrhea are to be avoided 
for when diarrhea develops in measles it is 
sometimes hard to check. 

There should be one daily cleansing sponge 
bath and the cooling sponge baths if the fever 
renders the child irritable and sleepless. These 
are given as directed in the first chapter. The 
warm tub bath will sometimes be ordered by the 
physician who will also prescribe small doses of 
aconite to relieve the fever and some sedative 
to ease the nervous symptoms, such as headache, 
restlessness, grinding of the teeth, or a tendency 
to convulsions. Constipation must be relieved 



70 DISEASES OF INFANCY 

by a mild cathartic because of the danger of 
setting up a diarrhea. Mineral oils are safe and 
enemas can be used if necessary. If the child 
becomes debilitated by persistent diarrhea the 
physician will prescribe one of the usual prepa- 
rations for checking it. Any vomiting will sub- 
side if the stomach is given a rest and the liquid 
diet carefully regulated. Drugs are seldom 
needed and a temperature even of 104° F. at 
the height of the attack does not call for special 
treatment if there are no unfavorable symptoms. 

The eyes must receive special attention; they 
should be carefully protected from the light and 
washed out frequently with a tepid solution of 
boric acid. Sterile vaseline should be applied 
to the lids to prevent them from adhering when 
the child is asleep. When the inflammation is 
severe the application of cloths wrung out of ice 
cold water will give relief. Throughout conva- 
lescence and for some time afterward the eyes 
should be carefully guarded from bright light. 
The child should wear a wide-brimmed hat and 
not read or study in a glare of light. The eyes 
should be washed with the boric acid solution two 
or three times during the day until all tendency 
to irritation has long disappeared. This measure 
for preventing weak eyes and a chronic tendency 
to disfiguring red lids should not be treated 
lightly. 

The mouth, nose and throat should be examined 



MEASLES 71 

daily for any complication that might arise herfc. 
An antiseptic spray should be used systematically 
to prevent the germs from spreading in the 
throat and to the lungs. This precaution will 
oppose the development of pneumonia. DobelPs 
solution or liquid albolene containing one or 
two grains of menthol to the ounce is used 
for this treatment. Your physician will order 
a sedative for the cough if persistent. If 
bronchitis or pneumonia develop they must be 
treated as directed in the chapters on those dis- 
eases. Guard against pneumonia by preventing 
all exposure, especially after the fever has dis- 
appeared, keep the room flooded with warm fresh 
moist air day and night, keep the child in bed and 
spray the nose and throat conscientiously as 
directed. 

While the rash is breaking out, should.it recede, 
a weakness of the heart may be indicated and 
your physician should be notified. He will prob- 
ably order the hot mustard tub bath as described 
in the first chapter which is of special use in 
such an emergency. 

Inflammation of the ear can generally be pre- 
vented by careful spraying of the nose and throat 
and by protecting the head at night, using a 
flannel cap if the weather is severe. If infection 
gets into the ear and severe earache develops, 
often accompanied by a sudden sharp rise in 
temperature, the ear must be carefully examined 



72 DISEASES OF INFANCY 

by your physician and if pus forms in the middle 
ear, the ear-drum must be opened to allow the 
pus to escape and the ear must be kept clean 
by syringing with an antiseptic solution of boric 
acid. This treatment is taken up in detail in the 
chapter on Diseases of the Ear. 

Special care must be taken during convales- 
cence because bronchitis and tuberculosis so 
often follow measles. The child needs a longer 
rest and careful building up before he is exposed 
to the rigors of daily life. He should be taken 
out-doors during the warmest part of the day 
in cool weather but never on a raw, windy or 
damp day. He should have plenty of rest until, 
by good nourishing foods, tonics of iron and cod- 
liver oil, his strength has returned. If a cough 
persists and the child remains delicate and fails 
to regain his strength, the lungs should be care- 
fully examined and there must be longer rest 
in the open air until the cough and lowered vital- 
ity have disappeared. Where it is possible, such 
a child should be sent to a warm dry climate for 
a time. Diet and hygiene should have strict 
management as laid down in the first chapter. 

GERMAN MEASLES 

The symptoms in German measles are very 
insignificant as this is one of the mildest of the 
acute infectious fevers. The coughing, sneezing 
and congestion of the mucous membrane of the 



MEASLES 73 

nose and eyes are all more or less trivial. The 
drowsiness, swelling of the face and fever are 
slight and sometimes not even noticed. These 
symptoms generally last only twelve to twenty- 
four hours or less. 

The child very commonly, without any com- 
plaint of illness, wakes up in the morning cov- 
ered with the characteristic rash of irregularly 
shaped, pale-red spots, slightly raised and in 
size varying from a pin-head to a pea. The spots 
may form a more or less close rash but are not 
grouped as in true measles, and may spread from 
the face where they first appear to all the extrem- 
ities within twelve to twenty-four hours, fading 
from the face and neck before they reach the 
feet. The rash is usually at its height the sec- 
ond clay and has faded by the fourth day and 
often sooner. There is no decided cold and often 
no catarrhal symptoms except a slight affection 
of the throat. There may be occasional sneez- 
ing, slight hoarseness, and little coughing, and 
some redness of the eyes. Sometimes the mem- 
brane of the throat is red and the tonsils swollen. 
In some cases there is an eruption of yellowish- 
red or brownish-red pin-head spots over the soft 
palate, uvula and the lining of the cheeks, which 
break out with a rash that lasts a few hours. 
Sometimes there is slight fever after the rash 
on the body has disappeared. The glands down 
the side of the neck in front and back of the 



74 DISEASES OF INFANCY 

ears are generally enlarged and this may con- 
tinue after the rash has faded. A very slight 
peeling may occur for a day or two. Occasionally 
German measles may be severe and then the 
symptoms are all more pronounced, with dizzi- 
ness, convulsions, or even bleeding from the 
eyes, ears and nose. This is, however, very 
rare as are also any complications. 

Treatment. — Beyond putting the child to bed 
in order to isolate him from the other children 
no special treatment is required. Isolation is 
needed because in the beginning the mother can- 
not be sure that this is not a case of true measles 
unless the child has had measles. The diet is 
regulated as in true measles and the nose and 
throat are kept clean by using an antiseptic 
spray. 

An attack of German measles does not pro- 
tect against true measles. From the time of 
exposure to the time the symptoms appear one 
to three weeks may elapse. 



CHAPTER VI 
CHICKEN-POX 

Chicken-pox is a disease most commonly 
appearing in children two to seven years of age 
and is readily transmissible from one child to 
another, generally occuring in epidemics. It 
takes eighteen to twenty-five days to develop 
after exposure and is contagious as long as any 
crusts remain on the skin. The symptoms are 
so slight that the child usually makes little com- 
plaint of illness. The temperature is usually 
100° F., rarely goes over 102° F. In severe 
cases the muscles may be sore. 

The rash is the first important sign and this 
comes first on the abdomen and back, although it 
may appear on any part of the body and abund- 
antly on the scalp with a few spots in the mouth. 
The rash appears first in raised red pimples. 
In twelve to twenty-four hours these become 
tense and filled with a clear fluid, the skin look- 
ing as though drops of water had been sprinkled 
on it. In twenty-four to thirty-six hours this 
fluid changes from a watery character to a milky 
pus-like secretion. During the fourth day, or a 

75 



76 DISEASES OF INFANCY 

little sooner, these pimples dry up, scabs form 
and drop off in a few days, seldom leaving a 
scar. Fresh rash appears during the first three 
•days so that before the fourth day the eruption 
can be seen in all its stages. The secretion from 
these little vesicles or pimples and the scabs 
which develop carry the contagion of this dis- 
ease. When the rash appears the temperature 
begins to fall although this may persist after all 
symptoms have disappeared. 

The attack from the beginning of the eruption 
until the skin clears takes about three weeks, 
sometimes longer. The disease runs a very 
favorable course in nearly all cases and after- 
effects are rare. It is very unusual for the most 
delicate child to die from the disease. One attack 
does not render the patient immune and some 
children have as many as three attacks of 
chicken-pox. Quarantine should be kept up until 
the skin is free from crusts; this stage of drop- 
ping all the crusts requiring about three weeks 
in most cases. 

Treatment. — The child should be isolated as 
soon as the rash appears and kept in bed for the 
first few days while the fever lasts. Very little 
treatment is needed. The tub-bath should be 
omitted while the eruption is on the body. The 
skin should be cleansed daily with gentle spong- 
ing with warm water, and boric acid should be 
added to relieve the itching of the skin (dissolve 



CHICKEN-POX 77 

two teaspoonfuls of boric acid crystals in a quart 
of boiling water, and cool). 

After the sponge bath, and several times dur- 
ing the day when the child is uncomfortable from 
the itching, gently rub over the skin where it 
is broken out, an ointment of twenty grains of 
boric acid to each ounce of sterile vaseline. This 
can be made more pleasant by using rose water 
ointment in place of the vaseline. This allays 
the itching and prevents the child from scratch- 
ing open the pimples with the fingernails and 
infecting them. Erysipelas may be started by 
this scratching, also ulcers and scars. 

During the fever, diet should be light, made 
up of milk, gruels and broth. The bowels should 
move freely each day; a mild cathartic such as 
aromatic cascara or milk of magnesia can be 
safely used, or the mineral oils can be employed. 

At times chicken-pox has been confused with 
small-pox but a child coming down with chicken- 
pox is scarcely ill before the eruption, while in 
small-pox the child is acutely ill and the symp- 
toms are severe before the eruption breaks out. 
In chicken-pox the eruption is very superficial 
(on the surface of the skin) while in small-pox 
the inflammation extends deeper into the skin and. 
the pimples feel tense and hard. 



CHAPTEE VII 
MUMPS 

Mumps is an infection of the glands at the 
angle of the jaw just below and in front of the 
ear. These are called the parotid glands, and 
are the important members which secrete saliva 
into the mouth. The lymphatic glands, which 
are situated just back of these, sometimes swell 
and this is mistaken for mumps. The child or 
adult has true mumps only once, but the lym- 
phatic glands may swell many times. Mumps 
is not only infectious but it can be transmitted 
from one child to another. The infection which 
causes this disease is located not only in the 
glands but also circulates in the blood, sometimes 
affecting other organs, most commonly the tes- 
ticles, but generally this is in adults. The ovaries 
and breasts in girls are sometimes affected. 
Death never occurs from mumps, a child never 
has a relapse or a second attack, and in children 
there are rarely complications. Children of the 
pre-school and school age are chiefly affected ; 
seldom infants or very young children. 

Mumps can be transmitted through association 

78 



MUMPS 79 

of one child with another, through a third per- 
son who has been close to the patient to the 
extent of getting some of the germs on the person 
or clothing and transferring them, and it can 
be carried on books, toys or other articles. Three 
to four weeks elapse from the time of exposure 
to the first sign of the swelling which does not 
completely subside for ten days to two weeks. 
Quarantine should be maintained until the swell- 
ing has entirely disappeared. 

The gland on one side of the face usually 
swells first and that gland is generally the one 
most affected, the swelling on the other side of 
the face rarely is as great and generally sub- 
sides much sooner. Sometimes mumps occur 
only on one side of the face, in other cases three 
or four days elapse before the swelling appears 
on the opposite side and this, as stated, is gen- 
erally slight, although there are some patients 
who have a severe case of mumps on both sides. 

Before the swelling appears the child may be a 
little feverish, tired, and have some pain at the 
angle of the jaw and experience pain and stiff- 
ness in moving the jaws. Sometimes the pain 
extends back into the ear and the child complains 
of earache. As the gland swells the tempera- 
ture may rise to 100° or 102° F. This fever 
will subside a little to rise again in a few days 
if the gland on the other side of the face becomes 
affected, which is more liable to occur in cold 



80 DISEASES OF INFANCY 

weather. Rarely do the fever and pulse go high 
enough to cause any anxiety. 

Treatment. — The child should be isolated until 
the swelling has entirely disappeared and should 
be kept in bed while the fever lasts. If kept 
in bed until the swelling goes down all complica- 
tions are avoided. 

The food should be liquid, such as milk, gruel 
and clear soup, never acid fruits because these 
cause great pain in the swollen glands, and 
should be taken in small sips because of the diffi- 
culty in swallowing. 

Unless the bowels move daily, give milk of 
magnesia which is the most suitable cathartic 
to use in mumps. Cloths wrung out of hot water 
applied to the swollen glands give relief, as 
does the hot water bottle, the skin being pro- 
tected from the bottle by two or three layers 
of cloth. Warm camphorated oil bound on with 
a hot flannel also allays the pain. 



CHAPTER VIII 
WHOOPING-COUGH 

Whooping-cough, because of its prolonged 
course and many complications, causes an over- 
whelming number of deaths each year. The larg- 
est number of cases occur in children under six 
years old and comparatively few after the tenth 
year. This disease is particularly hard on 
infants under a year old. 

Children are very susceptible to wiiooping- 
cough and nearly always contract it when 
exposed, as few are naturally immune. It is an 
infectious disease that first attacks the mucous 
membrane of the nose and throat and is caused 
by the action of a microbe that gets into the 
secretions there. The germ lives but a short 
time outside the body of the patient so that the 
clothing and objects the child touches lose any 
infectiousness in a brief period. But the sputum 
coughed up is very infectious and should be care- 
fully disinfected by a solution of corrosive subli- 
mate or burned, as described in the first chapter. 

The disease breaks out in from two to fourteen 
days after exposure and lasts from six weeks to 

81 



S2 DISEASES OF INFANCY 

several months. There are three stages: (1) 
the catarrhal stage, (2) the paroxysmal or 
whooping stage, (3) the stage of decline. These 
are not very sharply defined and they vary in 
length with different children. As a rule there 
are no symptoms to warn the mother. 

The catarrhal stage begins with sneezing, 
watering of the eyes, irritation of the throat, 
feverishness and cough. At first the cough may 
be mistaken for a simple cold or an attendant 
bronchitis, but later becomes hard, dry and dis- 
turbing. Gradually the cough becomes more 
severe, occurring in more and more frequent 
paroxysms, especially at night. This stage may 
last two or three days or more, often two weeks, 
sometimes longer. Usually the younger the child 
the shorter this stage which ends with the dis- 
tinct "whoop." 

The second stage shows a lessening of the 
catarrhal symptoms and an increase in the cough 
which comes in spasms of several short, quick 
coughs followed by the drawn-out "whoop." 
The child has a tickling sensation, a desire to 
cough with a smoothered feeling and a holding 
of the breath, then the series of explosive coughs 
so close together there is no time to breathe. 
The child gets red and sometimes blue in the 
face, the eyes bulge out, sometimes seeming 
about to burst from the sockets, the child seems 
about to suffocate or strangle, then the "whoop" 



WHOOPING COUGH 83 

comes, the louder it is the greater the relief. 
Such a fit of coughing will last for half a min- 
ute or more. There may be several spells in a 
few minutes; they may come on frequently or 
only two or three times during the day. They 
may bring on vomiting and this may occur so 
often that the child loses much of its food which 
is most unfortunate as the long course of the 
disease greatly debilitates the system. Occa- 
sionally the coughing may be so severe in a 
delicate child that blood bursts from the nose, 
mouth and ears, the eyes become blood- shot and 
the urine or feces be forcibly expelled. These 
spells seem to be brought on by the slightest 
cause, such as closeness in the air of the room, 
laughing, crying, talking, or simply swallowing. 
The attacks seem to be more troublesome 
indoors than out-of-doors and more severe at 
night. The severity of this stage increases up 
to the end of the second week as a rule but may 
last longer. It then gradually abates for thirty 
to fifty days, although in mild cases this stage 
may last only a week or ten days. In mild cases 
the "whooping" is troublesome only at night 
and these are the children who are apt to spread 
the disease to their playmates during the day- 
time. In severe cases, especially in very young- 
children and babies, the whooping gives way 
to a dangerous loss of breath with unconscious- 
ness. 



84 DISEASES OF INFANCY 

It is in this stage that complications arise 
that are of far greater danger than the disease 
itself, such as inflammation of the bronchial 
tubes and lungs, and convulsions, any of which 
may prove fatal. The greatest danger comes 
from broncho-pneumonia and the younger the 
child the more susceptible he is to this compli- 
cation which is also prone to menace the feeble 
or rachitic child. This is the child who is also 
most subject to convulsions during whooping 
cough. The convulsions may occur at any stage 
of the disease and are apt to be fatal to the 
debilitated child. 

During this second stage in healthy children 
the strength and general nutrition are not par- 
ticularly affected, but in the severe cases and 
with the child inclined to be delicate, the general 
condition suffers from loss of sleep, nervousness, 
and loss of food and appetite from constant 
vomiting. The child readily becomes emaciated, 
with loss of strength and greatly disturbed 
digestion. 

The third stage, or stage of decline, marks 
an abatement of the disease. The coughing 
becomes looser, less frequent and less severe, 
the characteristic " whoop' ' gradually disappear- 
ing. This stage lasts from one to three weeks. 
It is often prolonged by exposure in the winter 
season, a slight bronchitis may develop, ^with 
sometimes a return of the paroxysms of cough- 



WHOOPING COUGH 85 

ing, and afterwards there may be a more or 
less prolonged period of catarrh with occasional 
returns of the spasmodic coughing. 

Severe cases of whooping-cough often leave 
• their mark in permanent shortness of breath 
and a tendency to asthma, arid in a weakened 
and defoliated state which may bring out a 
dormant tendency to tuberculosis or tubercular 
broncho-pneumonia. Lowered vitality following 
a prolonged case of whooping-cough renders the 
child susceptible to such infectious diseases as 
measles, grippe, scarlet fever, typhoid fever and 
other of the dreaded diseases of this age. Of 
special importance is the fact that a severe 
depression of the nervous system which accom- 
panies prolonged whooping-cough is often accen- 
tuated by the constant giving of sedatives to 
relieve the paroxysms of coughing. 

THE TREATMENT 

Because whooping-cough is so highly infectious, 
because practically all children are easily suscep- 
tible, and the complications so dangerous, -the 
strictest quarantine should be observed in all 
cases no matter how mild, for the strong child 
with the mild case can readily infect the weak 
child who may suffer from the disease in its most 
prolonged and severe form. Isolation should con- 
tinue from other children for two to three weeks 
after the whooping has stopped. If the patient 



; 



86 DISEASES OF INFANCY 

is not confined to his room or indoors during this 
time, all children who are not immune should be 
kept away from the house and from the neighbor- 
hood where the epidemic has broken out. These 
precautions are especially applicable to all deli- 
cate children and others under three years of 
age. The room in which the child has slept dur- 
ing the attack, with the objects handled and used, 
should be fumigated and disinfected. 

The best treatment for whooping-cough is the 
fresh-air treatment, and the child should be kept 
out-of-doors as much of the time as possible dur- 
ing pleasant weather, but not on raw, damp or 
windy days because of the susceptibility to bron- 
chitis and pneumonia. Delicate and young chil- 
dren should receive their airing in a room flooded 
with an abundance of fresh air, and should be 
protected by proper clothing and caps. 

It is not necessary to keep the child in bed as 
long as the disease is progressing favorably and 
there are no complications, unless the child has 
become debilitated by persistent coughing and 
vomiting and needs the rest in bed to build up 
his strength. An abundance of fresh air in the 
sleeping room, playroom and out-of-doors dimin- 
ishes the paroxysms of coughing. 

The diet should be highly nutritious because 
the child becomes debilitated by the coughing and 
it should be easily digested because of the ten- 



WHOOPING COUGH 87 

dency to vomit after the coughing spells and be- 
cause the disease is depressing and weakens the 
power of digestion. Thoroughly cooked cereals, 
soft boiled eggs, milk, gruels, meat soups and a 
small amount of thoroughly broiled beef and mut- 
ton should be given. After severe attacks of 
vomiting only liquid foods such as gruel, milk- 
toast and milk should be allowed. 

Sedatives are sometimes necessary to relieve 
the severe paroxysms of coughing but these must 
always be prescribed by your physician because 
what will act well with one child is of little value 
with another and they must always be used with 
the greatest caution because of their depressing 
effect upon the nervous system which is already 
greatly depressed by the course of the disease. 
The persistent use of strong sedatives, especially 
over a considerable period, has a very unfortu- 
nate effect upon the child's nervous system and 
general resistance. 

Antiseptic sprays are of value during the 
attack for the nose and throat. A one per cent 
solution of resorcin is a good spray for the 
throat. And your physician will prescribe a 
spray containing a mild sedative to be used in 
the nose and throat to relieve the coughing when 
severe. Inhaling steam, as described under 
Croup, gives relief. (Ten to fifteen drops of 
resorcin should be put in the croup or tea-kettle.) 



38 DISEASES OF INFANCY 

Small doses of antipyrin given internally, 
always under the direction of your physician, 
are recommended in cases where no fever exists. 
In some cases it gives wonderful relief. In very 
young and weak children your physician may find 
it necessary, during the height of the attacks, 
to give a tonic for the heart. Diatussin will 
many times promptly relieve a severe paroxysm 
of coughing. Use two or three drops placed on 
the tongue for children after the third year. 
Four or five drops may be used if the smaller 
dose does not quiet the coughing. Repeatedly 
children obtain relief from the Vapo-Cresoline 
lamp burned in the room at night. Mild cases of 
whooping cough rarely call for any treatment 
other than fresh air and careful attention to diet 
and hygiene, with occasionally a little sedative at 
bed-time, prescribed by your physician to quiet 
the coughing during the night. 

Vaccine Treatment. — A vaccine has been pre- 
pared for whooping-cough treatment which has 
in many cases given most satisfactory results. 
Its use should be begun as soon as the child has 
been exposed to the disease. This vaccine has 
many times prevented the development of the 
disease and in other cases has made the attack 
lighter and shorter. Its use must always be car- 
ried out by your physician. 

Convalescence. — Special care should be given 
during the prolonged period of convalescence. 



WHOOPING COUGH 89 

The child should be carefully guarded in incle- 
ment weather against the dangers of taking cold. 
The iron tonics and cod-liver oil are especially 
valuable here as are all the nourishing and desir- 
able foods. (See Convalescence, Chapter I.) 



CHAPTEE IX 
VACCINATION 

Legislation making vaccination compulsory was 
introduced in Europe considerably more than a 
hundred years ago and this treatment has been 
so effective in stamping out smallpox epidemics 
that there is now little important contention 
against it. Its benefit has proved itself in the 
eyes of the whole world so that it has become a 
common practice in all large cities. One of the 
greatest proofs of the value of vaccination that 
has been brought to our attention in recent years 
has been its employment in the Philippine Islands 
where before its systematic use as a preventive 
by American doctors, smallpox periodically 
almost wiped out whole tribes. The disease has 
now been practically stamped out. 

Because we are so careful to vaccinate our 
school-children to protect them against smallpox, 
few mothers are brought face to face with the 
terrible suffering and mortality of this dreaded 
disease, and very few pock-marked persons are 
encountered. Vaccination is the process of intro- 
ducing into the child 's blood the virus from an 

90 






VACCINATION 91 

immunized cow. This renders the child immune 
from smallpox for a period of about five years. It 
is necessary to re- vaccinate every five years. It 
should be done by the physician and there is no 
danger when the skin is thoroughly washed 
and cleansed when the scratch is made and 
protected from any dirt or germ. The child 
should be kept away from anyone suffering 
from an eruption or a contagious disease as a 
germ might accidentally be rubbed into the vac- 
cination sore. There will be slight inflammation 
and redness around the vaccinated area for five 
to seven days and the physician will see that it 
is protected by layers of sterile gauze. 

During the active stage of the vaccination, 
which is from two to three weeks, the child should 
not eat meat or eggs but should be restricted to 
a diet of milk, cereals, vegetable soup or broth, 
vegetables and fruit and should drink plenty of 
water and fruit-juices. The bowels should be 
watched and kept loose. This is important. 

The cotton which the physician places over 
the vaccination should not be removed or changed 
unless it become soaked with secretion or soiled. 
But the gauze or linen protecting the cotton can 
be replaced when soiled by a clean piece of linen 
and a bandage. No salves or ointments should 
be applied. There may be slight itching and ten- 
sion while the scab is forming. From the fifth 
to the ninth day there may be slight fever which 



92 DISEASES OF INFANCY 

may run to 102° or 104° and then disappear. The 
child may be fretful, restless, not eat well, be 
languid and may occasionally vomit. 

Should the redness spread or the skin become 
swollen and the arm painful the physician will 
prescribe dressing the vaccinated area with gauze 
wrung out of a saturated solution of boric acid 
(warm). The swelling and inflammation will sub- 
side as a rule in a few days. Only in case of 
such inflammation or a fever over 101° need the 
child be kept away from school in order to remain 
quiet. 

Vaccinate the baby or child when it is in good 
condition, free from any eruption of the skin, 
and not in very hot weather. The vigorous baby 
not suffering from disturbances of digestion can 
be vaccinated at three or four months. If there 
is any danger from an outbreak of smallpox, vac- 
cination can be done in the first month. If a 
child is vaccinated in infancy it should be revac- 
cinated at five to seven years, again at puberty, 
and at nineteen to twenty-one. If a case of small- 
pox breaks out, all those exposed should be revac- 
cinated at once. If vaccination fails, it should 
be repeated. 



CHAPTER X 
INFANTILE PARALYSIS 

A few years ago there developed in the East, 
principally in New York, a few oases of infantile 
paralysis. The number increased until it reached 
the proportions of an epidemic, traveling west- 
ward across the continent, gaining a foothold in 
every state. It moved slowly and unchecked from 
Boston to Portland, Oregon, leaving hundreds 
of dead babies in its path and hundreds of chil- 
dren paralyzed for life. 

During this blighting outbreak medical men 
thoroughly awakened to the fact that the disease 
was contagious and consequently due to some 
bacteria or virus which could be carried from 
child to child and they spared no effort in their 
work to check this scourge. Many similar epi- 
demics had occurred in Europe and it was 
believed that the disease was brought to this 
country by immigrants. 

Its season of greatest prevalence is June to 
October and the largest number of cases have 
been recorded in the months of August and Sep- 
tember. It is a disease of early childhood occur- 

93 



94 DISEASES OF INFANCY 

ring most frequently during the first five years, 
although older children and adults are sometimes 
affected. 

The germ or virus which produces infantile 
paralysis gets into the body through the delicate 
membranes which line the nose, mouth and throat, 
and the virus escapes from the body in the 
same way; through the discharges of the nose 
and throat; although it is sometimes thrown off 
through the bowels. 

It goes directly to the spinal cord as soon as 
gaining entrance to the system. In the spinal 
cord are the cells from which the delicate nerves 
radiate to all parts of the body. Some of these 
cells control nerves which cause motion in the 
muscles, and some are connected with nerves 
which give rise to sensation or feeling instead 
of motion. The virus attacks the cells that con- 
trol the power of motion in the muscles and may 
temporarily injure or completely destroy an 
entire group of cells which control the muscles, 
for example, in the arm or leg or both arms and 
both legs. Thus a child may be paralyzed in 
one arm, unable to move it and yet have sensa- 
tion in it, because the cells controlling the nerves 
that are connected with sensation have not been 
attacked by the virus. 

One of the most striking and unusual features 
in this disease is that it produces the one bad 
result, paralysis. I have never known the suf- 



INFANTILE PARALYSIS 95 

ferer to be left with other unfortunate conditions, 
such as a weak heart or diseased lungs or 
derangement of the mind. And what is of great- 
est interest to mothers is the fact that most chil- 
dren never develop any weakness of the muscles 
or paralysis from this disease. Paralysis is the 
unusual result not the usual result. However, 
you must be on the alert lo recognize the symp- 
toms for the possibility of paralysis is always 
present in this disease and you must be ready to 
act promptly in using any safe method which 
will prevent it from spreading or from leaving 
the muscles permanently useless. - 

Three Different Cases. — There are three dif- 
ferent ways in which the child infected with this 
disease may become ill. There is the case of 
the child who will feel ill and out of sorts for a 
day or two and then for a few days or a few 
hours be apparently all right, to become ill again ; 
usually more seriously than in the beginning, 
often with muscular weakness and paralysis. 
This case is exampled by one little patient of 
mine, a nine-year-old boy who complained of 
headache. His mother noticed that he was fever- 
ish, but in twenty-four hours he was feeling per- 
fectly well again. Eight days later he had 
another severe headache and considerable fever. 
He was constipated and vomited several times 
within a few hours. The muscles of his thighs 
and calves were very tender; he complained bit- 



96 DISEASES OF INFANCY 

terly when his mother tried to move him in bed, 
saying that his muscles hurt. That night the 
muscles on one side of his face seemed to be 
weak. No further paralysis developed and the 
child was soon well. 

Again, a child may be taken ill and remain ill 
from the start. An example of this was the case 
of *a little boy of f ouf-and-a-half . One day he 
was very drowsy and irritable and this continued 
for three days. The mother then took his tem- 
perature and found that there was some fever. 
That day the little fellow cried with a severe 
headache and pain in the back of the neck. He 
was very constipated, and vomited three or four 
times. He laid in bed in a drowsy state, but 
making considerable fuss if his mother tried to 
move him. His eyes had a staring, glassy look. 
At any attempt to bend the head or body forward 
he cried out with pain and on account of the 
pain and extreme tenderness in the spine he 
held his head and back rigid. The spinal punc- 
ture was made in this case and some of the spinal 
fluid drawn off, relieving the pressure. The 
jhild recovered without any paralysis or sign 
of it. 

In the third case the child was acutely ill from 
the beginning and seemed to be overwhelmed with 
poisons. This was a little girl nearly four years 
old. She was suddenly seized at 10 o 'clock in the 
morning with severe pain in the back of the neck. 



INFANTILE PARALYSIS 97 

She was put to bed and in a very short time 
developed a high fever. She was very nervous. 
The spine was punctured and some of the fluid 
drawn off. In health this fluid is clear but in most 
cases of infantile paralysis it is .of a cloudy, milky 
appearance. That night the little girl seemed 
better and slept some. When she awoke her neck 
was very tender and stiff and any attempt to 
bend it forward caused her to cry out. There 
was no paralysis or weakness of the muscles. 
The following morning the child suddenly drew 
her head backward and lay in that position with 
her spine rigid. She began to breathe rapidly. 
The next day it was noticed that her right arm 
and leg were paralyzed. Several times the spinal 
canal was punctured and some fluid drawn off. 
Each time this was done the child seemed better. 
When this child recovered she was left with a 
paralyzed arm and leg. 

I have recorded these three characteristic cases 
that you may have a clear idea of the symptoms. 
It is true that paralysis seems to develop more 
often in the cases where the child is seriously ill 
from the beginning. It is impossible to foretell 
in the early days what the outcome will be. 
Sometimes children who are acutely sick with 
one # or both limbs completely paralyzed, make 
perfect recoveries. And often a mild attack is 
followed by permanent paralysis. 

The most distressing result of infantile paraly- 



98 DISEASES OF INFANCY 

sis is that as soon as the power of motion in the 
limb is lost, the limb ceases to grow and waste 
begins. The results are deformities, such as 
club-foot or shortened leg or arm. In some cases, 
instead of the entire limb, one muscle or a group 
of muscles may be paralyzed and the others 
escape. 

TKEATMENT 

The first thing to do is to get your physician. 
Put the child to bed in a room where you can 
have plenty of fresh air. Screen the windows 
if in warm weather, see that there are no flies 
in the -room and exclude everyone except the one 
who is to take care of the child. The bowels 
must be emptied immediately. Give a big dose 
of castor oil or aromatic cascara or compound 
licorice powder. Castor oil comes first if the 
child can be made to take it, the others are 
substitutes. 

I have found that some good comes from the 
use of urotropin, given in good big doses, diluted 
well with water, always under your physician's 
direction. This measure cannot do any harm 
and in some instances we believe it has done some 
good. 

The diet must be light and of food that is most 
easily digested, such as milk, eggs, broths and 
custards. 

For the first few days all handling must be 

y 



INFANTILE PARALYSIS 99 

forbidden, because any movement of the body 
may be very painful, and the inflamed nerves 
need absolute rest. And as long as there is any 
tenderness, massage is absolutely the wrong 
measure. The inflamed nerves must not be irri- 
tated or stimulated, by rubbing or by drugs. 
Until the pain has gone out of the affected limb, 
until all the tenderness has vanished completely, 
the limb must not be rubbed or massaged. But 
the moment the tenderness and pain have gone, 
then the muscles must be massaged faithfully, 
every day, starting gradually. If you cannot 
have a trained nurse or professional masseuse, 
or someone skilled in giving massage, your phy- 
sician must show you how to give the massage 
and manipulate the muscles that are affected. 

Of even greater importance than the massage 
in keeping up the circulation in the affected limb 
and to tone the muscles is to get the child to vol- 
untarily move and exercise the muscles that have 
been affected. The child is tired, he has been 
very sick, you must induce him, coax him, to try 
to move the limb that has been paralyzed a little 
each day, but always have him stop short of 
fatigue. This must be kept up with infinite 
patience day after day. Electricity is used suc- 
cessfully in stimulating these muscles and 
strengthening them. Your physician can obtain 
a small battery for you and direct you in its use. 

When the child gets on his feet after having 



100 DISEASES OF INFANCY 

had a limb affected he must be encouraged in 
every way to use it and not to depend upon a 
crutch. The use of massage, electricity and per- 
sistent trying on the part of the child has resulted 
in most startling recoveries when things seemed 
almost hopeless. The child must be helped to 
persist for months. 

When the paralyzed limb begins to show any 
deformity, such as the ankle turning over, your 
physician will have braces provided to prevent the 
deformity from developing permanently. While 
the brace will be heavy and the child will find it a 
burden to exercise the leg held in the brace, still 
it can get massage and considerable exercise and 
is growing in the right direction. Without the 
brace it may get more exercise and the muscles 
may become stronger in less time, but the deform- 
ity is developing instead of being corrected. 

All kinds of gymnastic exercises must be de- 
vised to bring the weak muscles into play and 
the treatment persisted in over a long period of 
time, for splendid results are obtained in cases 
promising nothing at the start. 

SicJc-Room Directions. — Because in our recent 
epidemic, infantile paralysis was found to be as 
infectious as smallpox, conscientious care must 
be exerted in preventing contagion. 

1. All suspicious cases should be reported imme- 
diately to the health authorities. 



INFANTILE PARALYSIS 101 

2. Children affected must be rigidly quarantined. 

They must not come in contact with other 
children. • 

3. Children affected are better off not only for 

those about them, but for their own recov- 
ery, if isolated, and if possible in a hospital. 

4. Sick-rooms must be screened and kept free 

from flies and insects. Infantile paralysis 
virus has been found in the bodies of stable 
flies. 

5. All secretions from the mouth, nose and intes- 

tines ■ should be disinfected by burning or 
with carbolic acid or other disinfectant. 

6. The bed-clothing, towels, books and toys must 

be disinfected by boiling or burning. 

7. Household pets must be excluded from the 

sick-room. Animals are a very common 
carrier of the virus of infantile paralysis. 

8. Milk bottles or cans must not be moved from 

the premises where this disease exists and 
milkmen must not touch these containers. 

9. Every member of the family and those in the 

neighborhood where the disease has entered 
should use peroxide of hydrogen as a gar- 
gle at least twice a day. 
People who are apparently perfectly healthy 
can be carriers of the disease on the membranes 
of their noses and throats and coming in contact 
with children might be the means of introducing 
the disease. 



102 DISEASES OF INFANCY 

The care of the teeth is of great importance 
because around decayed teeth and sore gums the 
virus may gain entrance into the blood. 

During outbreaks of this disease it is impera- 
tive that children be kept from school and public 
places. The whole problem, as the mother read- 
ily sees, is prevention. If the disease develops 
in your locality establish a rigid quarantine to 
protect your own family, your neighborhood and 
your town. 



CHAPTER XI 

COLDS, CATARRH,' CROUP, INFLUENZA . 
AND THEIR COMPLICATIONS 

Colds and influenza are due to an infection just 
as much as are measles and scarlet fever. The 
infection lodges in the mucous membrane of the 
nose and throat and the cold develops. 

Simple, ordinary infections produce simple 
ordinary colds. But if a true influenza germ 
gains a foothold on the mucous membrane there 
develops a case of true influenza or la grippe. 

A simple cold, a coryza, is very contagious, 
quickly traveling from one member of the family 
to another. The symptoms, sneezing, watery 
eyes, a "stopped up" nose, are accompanied com- 
monly by a degree of fever. In a day or two the 
watery discharge becomes purulent, the mem- 
brane of the nose swells making breathing 
difficult. 

The danger in colds is that the infection in the 
nasal cavity rapidly spreads to the throat, ton- 
sils, pharynx and bronchial tubes, resulting in 
serious and exhausting chronic diseases. 

In babies, cold in the head easily causes inflam- 
mation of the ear. If you find the little one con- 

103 



104 DISEASES OF INFANCY 

stantly putting one hand to the ear and crying 
out in pain or rolling the head from side to side, 
call your physician's attention to it at once. The 
infection in the nose and throat often travels up 
the eustachian tube which leads from the back 
and upper part of the throat to the middle ear 
and sometimes forcibly ruptures the ear-drum. 
This may leave the hearing impaired or cause 
deafness. The physician. who recognizes this con- 
dition at once and opens the ear-drum, allowing 
the pus to escape through a small incision, will 
save your child's hearing. 

Repeated colds cause adenoid growths in the 
posterior nasal cavity. There are sonie diseases 
which start with a cold. This is true of measles, 
the eyes becoming very red, a dry, hacking cough 
developing and very shortly followed by the erup- 
tion. 

Diphtheria, which sometimes develops its mem- 
brane first in the nose, may appear like a simple 
cold in the head, but the discharge from the nose 
in diphtheria is very excoriating to the skin of 
the lips and face and is usually tinged with blood. 
Very often diphtheria discharge is from one nos- 
tril only while the discharge from simple colds 
in the head comes from both nostrils. 

Influenza or la grippe usually starts with a cold 
in the head and with high fever and pains in 
various parts of the body, the child appearing 
quite sick. In simple colds in the head there is 



COLDS, CATARRH, CROUP, INFLUENZA 105 

only a slight fever and the child is not otherwise 
very ill. 

A simple cold may last but a few hours or a 
few days in sturdy children. In those more deli- 
cate it may hang on, one following another for 
a long period. 

Another complication which may come from a 
simple cold is that the infection may lodge in 
the tonsils and from there be carried to the 
glands of the neck, which become swollen and 
painful, sometimes to such an extent that they 
have to be opened, which is apt to leave a dis- 
figuring scar on the neck. When the infection is 
carried to the glands it is absorbed into the gen- 
eral system in small amounts until it has dis- 
appeared. This has a marked debilitating effect 
on the child, blocking, in a measure, the normal 
growth and development. 

You will hardly ever mistake influenza for the 
simple cold because of the difference in the sever- 
ity of the symptoms. The child with the cold 
will want to be up and play about the house, 
while a child with true influenza prefers to 
remain in bed and usually protests or cries if 
attempts are made to lift him because the mus- 
cles are so tender and painful. 

The infection may also spread down into the 
bronchial tubes, producing acute bronchitis which 
may develop into the more serious disease of 
broncho-pneumonia. 



106 DISEASES OF 'INFANCY 

For these reasons it is imperative that as soon 
as a child develops any symptoms of a cold, 
prompt and energetic treatment be resorted to 
before any of the complications have a chance 
to develop. 

Influenza may not start with a cold in the head 
but with a simple sore throat. The child who 
complains of difficulty in swallowing should have 
his throat examined at once. The entire throat 
will be reddened and the tonsils may or may not 
be swollen and enlarged. At times small white 
spots will be seen on the tonsils. The character 
of these spots is discussed more in detail under 
the subjects of tonsillitis and diphtheria. The 
child that is old enough will complain of head- 
ache, pain in the limbs and be very dull and 
listless. At the beginning of the attack the child 
may complain of being chilly or even have a dis- 
tinct chill. 

At times influenza makes its appearance with 
symptoms of disturbed digestion. The throat 
may be only slightly red; the child may vomit 
two or three times and diarrhea set in. Almost 
invariably there will be lots of pain in the abdo- 
men and the mother may be at a loss to know 
whether it is true influenza or a disturbance of 
digestion. But the redness of the throat and the 
complaint of headache with pain and tenderness 
in the muscles will point to the presence of 
a case of influenza. 



COLDS, CATARRH, CROUP, INFLUENZA 107 

TBEATMENT 

At the very beginning of a cold in the head 
take steps to prevent its spreading to some 
other part of the body and to some other person. 
Teach the child not to sneeze or cough near any- 
one r s face. Do not let him sleep with the other 
children. Do not send him to school where he 
can not only spread the infection but, in his 
weakened state, may pick up a worse infection 
which he cannot resist. When your child devel- 
ops a severe cold or has an attack of grippe, put 
him to bed in a separate room. If you wait on 
him yourself, have an apron to slip on which 
covers your, dress completely and be careful that 
the bits of old cloth you give the child for his 
nose or to spit in are carefully burned, that he 
does not accidentally sneeze in your face, that 
his cup and spoon and towels are not used by 
others. These simple little precautions that are 
rigidly observed in hospitals would prevent 
countless cases of infections in the home, and 
save the mother the work and worry of a large 
percentage of the family illness. 

The first thing to do is to give a cathartic to 
clean out the bowels so that the germs which may 
have gotten into the intestinal tract may be car- 
ried out. Give a hot bath and a hot mustard foot 
bath and get the child into bed under warm cov- 
ers in a room supplied with plenty of fresh air 



108 DISEASES OF INFANCY 

but out of all draughts. If the castor oil does 
not act freely in the beginning, give an enema of 
warm water and soap-suds, for the bowels must 
be emptied. 

Clear the nose and throat. Have your, drug- 
gist put up menthol and liquid albolene, one- 
half grain of the former to each ounce of the 
albolene. By means of a medicine dropper put 
three drops in each nostril every hour. This 
soothes the inflamed membrane and affords great 
relief, making breathing easier. This is for 
children under two years. For older children, 
use a spray of one grain of menthol to one ounce 
of liquid albolene, and spray each nostril well 
every two hours. This must be done gently, not 
with force because you do not wish to force any 
of the infection back into the tubes leading to 
the ears. And, remember, the nose should always 
be blown carefully, closing one nostril and blow- 
ing through the other, not closing both nostrils 
and blowing forcefully. This is a common mis- 
take. 

If the cold is taken in hand in the very begin- 
ning, as soon as you have given the cathartic 
start giving tincture of aconite. For a child 
under two years, put five drops of tincture of 
aconite in one-half glass of water and give one 
teaspoonful every thirty minutes until you have 
given eight doses. For the child between two 
and four years, use ten drops in one-half glass 



COLDS, CATARRH, CROUP, INFLUENZA 109 

of water and give in the same way. For the 
child between four and ten years, use fifteen 
drops in one-half glass of water, and after the 
tenth year you can give one drop of tincture of 
aconite in one teaspoonful of water every thirty 
minutes for six doses. 

Another prescription to follow in the begin- 
ning of a cold or attack of influenza, to be used 
under your physician's directions, is a combina- 
tion of camphor, belladonna and Dover's pow- 
der, the dose varying with the age of the child. 
For children from one to four the prescription 
is 1/20 grain of extract of belladonna and 1/6 
grain of powdered camphor with 1/5 grain of 
Dover's powder, put up in powders. Take one 
powder dissolved in milk or a little peach juice, 
every two hours for ten doses, or until the cold 
is decidedly broken up. The child of four to ten 
years should take the powder made up in the 
following proportions: 1/15 grain of extract of 
belladonna, y± grain of powdered camphor and 
y 2 grain of Dover's powder, every two hours. 
After the tenth year, the powder can be taken in 
the following proportions : 1/10 grain of extract 
of belladonna, y 2 grain of powdered camphor 
and 1 grain of Dover's powder, taking one pow- 
der every two hours for ten doses or until the 
cold is decidedly better. 

Keep the child in bed, spray the nose and give 
plenty of water to drink and see that the bowels 



110 DISEASES OF INFANCY 

are kept active. The next important measure 
is the diet. In our experience with the "flu" 
in the recent epidemics of grippe or influenza, 
we have found, unless some special condition 
arises, rapid recovery will be secured if the child 
is put to bed after the hot bath and hot mustard 
foot bath and the other measures just mentioned 
and if his diet is carefully restricted for a few 
days to nothing more than milk which has been 
boiled, gruels and fruit juices, with an abundance 
of water, and with very little medicine of any 
kind. The child must be encouraged to drink 
water and lots of it. It can be made more pal- 
atable in the shape of lemonade or orangeade. 

It is important that the child or adult under- 
going this treatment be kept in bed until the 
fever has been absent for four or five days, and 
when allowed to get up, not be permitted to go 
out into the cold or to be exposed in any way 
until he has gotten his strength back. After 
attacks of the grippe or influenza children do 
not resist colds well. Most all the serious trouble 
in the last epidemic came from allowing people 
out of bed too soon and out-of-doors while they 
were still weak and exhausted. 

OATARRH 

We frequently have children who, while not 
suffering from any acute inflammation of the 
nasal cavity, have a chronic and persistent dis- 



COLDS, CATARRH, CROUP, INFLUENZA 111 

charge from the nose. This is very annoying 
and may persist even throughout the summer. 
There are a number of causes for these chronic 
discharges. In the first place, it is safe to say 
that a large majority of the children suffering 
from this chronic discharge have adenoids. An 
examination should he made and if they are 
found they should be removed. 

Another cause is the acute rhinitis or cold 
which goes untreated. The infection gets started 
in the delicate membrane of the nasal cavity and 
produces a chronic, pus-like discharge from the 
nose. Eepeated colds often cause the membrane 
to become chronically thickened and swollen, and 
this will keep up a persistent discharge. 

Children who are under-deyeloped or sickly 
from any cause, have very often a chronic, watery 
discharge from the nasal cavity. It is probably 
due to the fact that in the child's weakened state 
all the tissues and membranes have relaxed. 

, Another cause, which is found in children 
brought to the hospitals, is the presence of some- 
thing that the child has forced up into the nasal 
cavity, such as a bean or shoe button or little 
piece of wood or other material. The introduc- 
tion of any such foreign substance will cause 
a chronic discharge from one nostril. 

A chrpnic discharge which is occasionally seen 
and which resists the usual treatments is found, 
upon microscopic examination, to be due to the 



112 DISEASES OF INFANCY 

germ which causes diphtheria, and this is cured 
by administering the diphtheria anti-toxin. 

All these causes should be reviewed and a thor- 
ough examination made by your physician to 
determine which one is responsible. If adenoids 
are found present, even in a mild degree, they 
should be removed. If there are growths or 
enlargements of the membrane, or little bones in 
the nose, they should be taken care of by one 
skilled in that line of work. In a case of chronic 
pus-like discharge which has followed acute cold 
in the head, the nasal cavity should be sprayed 
with an ounce of liquid albolene in which two 
grains of ichthyol are dissolved. This should 
be used in an atomizer and gently sprayed into 
the nasal cavity every two or three hours during 
the day. The child should be instructed in deep 
breathing exercises and encouraged to keep the 
nose as clear as possible by careful blowing 
one nostril at a time, not both. 

The prevention of catarrh is in the care of 
colds when they first start, in not allowing them 
to become chronic, in removing adenoids, in cov- 
ering the head at night in winter with a sleeping- 
cap, in not remaining in draughts, in not wetting 
the hair and going out-doors before it is dry. 
Remember the child who is repeatedly catching 
cold, has enlarged tonsils or adenoids or is run- 
down, and these are the children who need strict 
training in all the rules of hygiene laid down in 



COLDS, CATARRH, CROUP, INFLUENZA 113 

the volume of this series entitled, Maternity and 
Child Care. Special attention to diet, clothing, 
hygiene and the deep-breathing exercises are the 
corrective measures. A child who is anemic, 
who has thin blood, should be handled in accord- 
ance with the directions in the chapter on Anemia 
in this book. 

A very splendid hardening process for children 
who have a tendency to colds, sore throat and 
catarrh, is the warm bath followed by the cool 
sponge around the throat, neck and chest. The 
temperature of the cool water can be gradually 
lowered, as the child reacts well to it, until the 
throat, chest and neck are sponged every day 
with cold water. Rub the neck and chest briskly 
with a towel after the sponge or splash of cold 
water, and if the child does not feel cold, and the 
skin reacts with a pink glow, this can be wisely 
continued. 

Attention should be given to the clothing in 
winter. Too many children are dressed too 
warmly indoors in winter and allowed to run out 
into a temperature twenty degrees lower without 
sufficient extra wraps. The child who is accus- 
tomed from babyhood to be sent out-of-doors even 
in the very cold weather, every day, warmly clad, 
is the one who will escape colds. 

Eemember, as a final word on this subject, 
fresh air is our greatest preventative and cure 
for colds. 



114 DISEASES OF INFANCY 

CKOUP 

Croup, while it causes mothers much alarm, is 
not dangerous. It is almost always the result of 
exposure to cold, but may be due to indigestion 
or some irritation in the throat. Croup often 
develops with cold in the head and some children 
are especially liable to repeated attacks. 

Croup usually begins with hoarseness, late in 
the afternoon or in the evening and a peculiar, 
sharp, racking metallic cough develops. The 
child may go to sleep and sleep three or four 
hours, then suddenly awaken, sit upright in bed, 
grasping at anything it can reach and appear 
to be unable to gets its breath. The cough then 
becomes loud, the breathing hard and the voice 
extremely hoarse. This may last for half an 
hour, an hour or several hours before the spasm 
relaxes and the child drops to sleep. Other 
attacks may recur for several nights in succes- 
sion. Croup is most liable to occur during the 
third and fourth years, the attacks usually 
decreasing after that and disappearing by the 
sixth vear. 

The treatment is one of prevention. A child 
subject to croup should be guarded with great 
care against exposure to draught, high winds and 
to dampness. If the little one is subject to 
croupiness in the afternoon or evening, the 
mother should begin administering some medi- 



_ COLDS, CATARRH, CROUP, INFLUENZA 115 

cine before the attack comes on. An excellent 
mixture is made up of two and one-half teaspoon- 
fuls of syrup of ipecac, one-half teaspoonful of 
potassium bromid dissolved in two ounces of 
cinnamon water. A child two years of age can 
take one teaspoonful of this mixture every hour 
for three or four doses. 

When the attack comes on in the night and the 
child is in a serious condition there are two 
things to do. One is to get the little one to vomit- 
ing and the other is to place him immediately in 
a hot bath. Many children will be promptly 
relieved of the spasm by vomiting. There are 
several household remedies you can use to cause 
vomiting, such as : 

1. A teaspoonful or more of syrup of ipecac, 

repeated in fifteen minutes. 

2. A glass of warm water with as much common 

salt as it will dissolve. 

3. A half teaspoonful of powdered alum stirred 

up in syrup or in molasses. 

4. A teaspoonful of mustard in a large quantity 

of warm water, if other emetics fail. 
The other treatment of value is the inhaling 
of warm steam vapor. The easiest and most 
practical place to give this treatment is in the 
child's crib, which should be covered with a sheet. 
An open umbrella may be substituted when a 
crib is not available. Place the child under the 
umbrella on the bed or in the baby carriage, 



116 DISEASES OF INFANCY 

covering all with a sheet. Any means or appa- 
ratus is adequate which will furnish steam and 
conduct it to the enclosed space. The Holt croup 
kettle when obtainable, is most convenient to use. 
The steaming should be continued until the croup 
is relieved. The sheet should be lifted occa- 
sionally for a few moments to allow a change of 
air. Usually a child may be kept under the tent 
from twenty minutes to one-half hour without 
such a change. The tent should not be so close 
as to prevent all ventilation. 

A good dose of castor oil should be given after 
the spasm and the medicine mentioned in the 
beginning should be started next day in the after- 
noon to prevent a recurrence of the attack. 

A child subject to croup should have his throat 
examined for enlarged tonsils and adenoids, and 
severe croup calls for your physician's attention. 

COUGHS 

The cause of annoying and persistent coughs 
often baffles the mother and physician. In prac- 
tically every case, examination will show that 
the nose, throat, bronchial tubes or lungs are 
involved. Adenoids, not necessarily those so 
enlarged that they block the nasal passage, are 
a most common source of the persistent cough. 
Very small adenoid growths can throw off a 
secretion that keeps trickling down the throat 
causing cough, which is worse at night because 



COLDS, CATARRH, CROUP, INFLUENZA 117 

the secretion gathers in the back of the throat. 

These are the children that have a catarrhal 
discharge from the nose and who repeatedly take 
cold. Because these adenoids are not large 
enough to interfere with breathing and cause the 
adenoid expression, they are often overlooked. 
Your physician can feel these small enlargements 
at the back of the nose with his finger, and will 
promptly curette them out. 

Enlarged tonsils are commonly a cause of 
persistent cough and their removal will promptly 
stop the symptom. In searching for the cause 
of a persistent cough the lungs must always be 
examined. A small spot of pleurisy will cause 
enough irritation to keep a child continually 
coughing. If tuberculosis is suspected to be the 
cause of an habitual cough the von Pirquet skin 
test for tuberculosis should be made at once. 
Repeated colds leave a chronic inflammation of 
the large bronchial tubes and the child will com- 
plain of a burning sensation in the upper part 
of the chest. Hard coughing is a symptom of 
this condition, and the child should receive the 
treatment for acute bronchitis. 

The so-called "stomach-cough" rarely exists 
except as an inflammation of the throat known 
as pharyngitis, caused by indigestion. At times, 
the irritation from worms in the intestine causes 
coughing, but this is rare. 

Coughing that persists is also a symptom of 



118 DISEASES OF INFANCY 

whooping-cough. Many children are given cough 
syrups uselessly for a long time. The only treat- 
ment is to find the cause and remove it, which 
calls for a careful study of the child. 

SIMPLE SOKE THROAT 

Simple sore throat in which the tonsils are not 
involved but the back part of the throat only is 
reddened and sore, and where there is a little 
fever and the hard, dry cough, is almost always 
due to indigestion from an overloaded stomach, 
or from chronic intestinal indigestion, (See 
Intestinal Indigestion.) 

Treatment. — The regular diet should be 
stopped and gruels, stewed fruits and chicken 
broth should be given. Four doses of one-tenth 
grain calomel each, at one hour intervals should 
be taken, followed a half hour after the last dose 
by rhubarb and soda to sweep out the calomel. 
Give doses of rhubarb and soda for four days, 
an hour-and-a-half to two hours after each meal. 
Gargles ■ are rarely necessary for simple sore 
throat. When the tonsils are involved the treat- 
ment for tonsillitis must be followed. 



CHAPTER XII 

THE TONSILS, TONSILLITIS AND ADENOID 

GEOWTHS 

The tonsils are almond-shaped structures like 
glands, situated one on each side of the upper 
part of the throat and easily seen when enlarged 
or swollen. 

Adenoids are a spongy overgrowth of tissue 
which develop just above the tonsils at the back 
of the nasal cavity. It is important to consider 
these two structures together because they form 
the main camping-ground for disease germs. Sit- 
uated close together and similar in their tissue 
formation, disease in one quickly travels to the 
other. Neglect in applying the necessary treat- 
ment promptly leads to more numerous and seri- 
ous complications in the child's growth and entire 
future life, than any other one thing unless it is 
improper feeding. 

Connected with the tonsils by lymphatic chan- 
nels are the lymphatic glands, many of which 
are found on each side of the neck. These glands, 
like the tonsils and adenoid growths, are com- 
posed of loose sponge-like tissue held together 

119 



120 DISEASES OF INFANCY 

by bands of firmer tissue which permeate them 
like a net. The purpose of the lymphatic glands 
is to remove germs from the lymph stream which 
flows through the glands into the blood, and pre- 
vent them from entering the general circulation. 
When the glands are not in a healthy state, or 
when bacteria get in through tonsils that are dis- 
eased and multiply in overpowering numbers, the 
glands are not able to destroy the disease germs 
and they enter the blood and are carried to other 
parts of the body. 

In the tonsils where the denser bands of tissue 
enter the softer tissue there are furrows and in 
these depressions the germs that enter the mouth 
through the air or food lodge and are able, if the 
tonsils are inflamed or diseased, to get through 
into the lymph channels. When germs get into 
the mouth in great numbers and suddenly pro- 
duce a violent attack upon the tonsils we have 
acute tonsillitis. After several such attacks the 
tonsils become chronically inflamed and enlarged 
and after repeated infections they constantly 
harbor the most virulent germs. We then have 
the condition of chronically infected tonsils. 

CHKONICALLY DISEASED TONSILS 

Almost every known kind of bacteria is found 
in chronically diseased tonsils, not only in the 
depressions or crypts, but throughout the tonsil 
tissue which may contain many diseased areas 



MASTOID 
OCCIPITAL 



DEEP 

CERVICAL 

CHAIN 




PAPOTID 



NODES OF 

EXTERNAL JUGULAR 

CHAIN 



PAROTID 

FACIAL 

SUBMAXILLARY 
SUBMENTAL 




^ FACIAL 



SUBMAXILLARY 



NODE OF 

INTERNAL JUGULAR 
CHAIN 



Top — The Lymphatic Glands of the Face and Neck. Bot- 
tom — The Lymphatic Channels Running to the Glands 
from the Face, Mouth and Throat. 



122 DISEASES OF INFANCY 

or pus pockets filled with pernicious bacteria in 
countless numbers and of many different kinds. 
The tonsil that has thus become permanently 
diseased, if allowed to remain in the throat, can 
produce and throw into the blood stream, the 
germs that cause rheumatism, heart trouble, 
Bright ? s disease, chronic bronchitis, pneumonia, 
tuberculosis, meningitis, anemia and a long train 
of ills that result from a slow poisoning of the 
entire system. 

Among the most pathetic sights of childhood 
are the thousands crippled for life by joint infec- 
tions following attacks of acute tonsillitis where 
diseased tonsils have been left in the throat. 
Another pitiful condition is the neck filled with 
disfiguring scars often with running sores caused 
by the lancing of glands which became filled with 
pus from inflammations caused by bacteria that 
got through diseased tonsils into the lymph 
stream. In many cases we find the bacillus 
which causes tuberculosis operating with other 
germs in the lymph glands which makes the 
tubercular bacillus more active and destructive. 
Tuberculosis once seated in the glands of the 
neck easily invades other organs of the body. 

Infections in acute or chronic tonsillitis may 
attack the heart, inflaming the lining of the heart 
or the heart muscle itself. Serious sickness and 
a permanently weakened heart results if this con- 
dition is allowed to go untreated. 



TONSILS AND ADENOID GROWTHS 123 

The kidneys are in turn affected by the poisons 
absorbed from diseased tonsils, and often after 
repeated acute attacks or when chronically dis- 
eased, Bright 's disease develops and oftentimes 
leaves chronically diseased kidneys. 

Removal, the Only Remedy. — The only remedy 
for diseased tonsils is their entire * removal at 
once. Tonsils subject to repeated attacks of ton- 
sillitis, or those chronically enlarged or inflamed, 
and above all, tonsils which you suspect are pro- 
ducing symptoms that could be traceable to them, 
should be removed. When you feel moderately 
sure that the tonsils are infected, have them 
removed. When in doubt, have them removed; 
not next spring or next fall; but now and save 
yourself and your child a long train of trouble. 
Your physician can do this or direct you to a 
specialist. 

Gargles and sprays and local treatments do not 
reach the source of the trouble when once the 
infection has gotten into the substance of the 
tonsil. Every day lost means so much more 
for the system to fight and a greater handicap to 
your child's chances for health. 

Whether the operation for removing the tonsils 
is done at home or at the hospital, keep the child 
quiet in bed for four or five days, preferably a 
week. The practice of letting the child walk 
home after an operation and take up the usual 



124 DISEASES OF INFANCY 

routine, without the period of rest and quiet is 
to be emphatically condemned. 

ACUTE TONSILLITIS 

Children of all ages, frequently babies, have 
acute tonsillitis. One attack leaves a tendency 
to others because, as we have seen, the crypts 
of the tonsils once infected make a good field in 
which new bacteria readily develop. 

An attack of tonsillitis begins suddenly, usually 
with a severe chill, and sometimes with convul- 
sions. Fever is always present and ranges from 
100° to 103°. There is lassitude, loss of appe- 
tite and soreness of the muscles. The tonsils 
promptly enlarge, the throat pains and swallow- 
ing is difficult, particularly in the younger child. 
By depressing the tongue with a spoon the tonsils 
can be seen very reddened and swollen, some- 
times with small white spots scattered over their 
surface. These spots are in the crypts and are 
the products which the bacteria throw out. 
(See illustration on page 48.) The spots may 
spread over the entire tonsil forming a false 
membrane resembling the diphtheritic mem- 
brane. The only way to tell whether this is 
the membrane of diphtheria or tonsillitis is by 
having a smear from the child *s throat examined 
in a bacteriological laboratory. This examination 
is made by all Boards of Health. If there is any 
doubt in the physician's mind he will not wait 



TONSILS AND ADENOID GROWTHS 125 



• 



for the report to come back from the laboratory, 
but will give diphtheritic anti-toxin at once. If 
the examination later shows that the membrane 
is not that of diphtheria no harm is done by the 
anti-toxin, if diphtheria is shown the prompt 
injection of anti-toxin will be the means of sav- 
ing the child 's life. 

The Treatment. — In tonsillitis, even of a sim- 
ple nature, the child should be isolated because 
the disease is very infectious and often occurs in 
epidemics. The treatment is to keep the throat 
cleansed and relieve the pain. Nothing answers 
the purpose so well in children of all ages as 
frequent irrigations of the throat with large 
quantities of hot salt solution. This is best 
accomplished with a fountain syringe. First 
sterilize the hard rubber point by boiling. Put 
two teaspoonfuls of salt in one quart of water 
and use as warm as can be borne. It is better 
to give these irrigations with the child lying down 
instead of sitting up, the head turned to one 
side and held over a basin. Hold the rubber 
tube in the mouth, elevate the syringe about two 
feet above the child's head and allow the hot 
solution to flow freely over the tonsils and out of 
the mouth into the basin. 

This relieves the pain and swelling and 
cleanses the throat of bacteria and their products 
which are on the surface of the tonsils in great 
numbers. It should be repeated every four or 



126 DISEASES OF INFANCY 

five hours and continued until all the inflamma- 
tion is gone. 

Internally, first clean out the bowels thoroughly 
by using calomel or castor oil. Calomel given 
in small doses has a very good effect. Use one- 
twentieth grain for a child under three given in 
a teaspoonful of milk or water every half hour 
for five doses. For children over three, one-tenth 
grain given in the same way. After the fifth 
dose give milk of magnesia or rhubarb and soda 
to sweep out the calomel. 

Because tonsillitis is so often followed by rheu- 
matism it is a very excellent plan to give from 
the very beginning of the attack two grains of 
sodium salicylate, every four hours in a half 
glass of milk for a child of two to four years; 
four grains to a child of four to six years; five 
grains for a child six or seven, and seven for 
older children. This is continued for eight or 
ten days. This is a protection to the heart and 
the whole system against rheumatism. 

When the glands of the neck are swollen, 
especially in older children, cracked ice in cloths 
or ice-bags or cold compresses give great relief 
when applied one on either side of the throat. 

Small children who will not gargle and who 
resist irrigations of the throat can be given three 
or four drops of tincture of chloride of iron every 
one or two hours until the inflammation has dis- 
appeared. Give this clear from a teaspoon so that 



TONSILS AND ADENOID GROWTHS 127 

it comes in contact with the tonsils full strength. 
Put it well back so as to avoid the teeth, if possi- 
ble, and do not let the child drink water for thirty 
minutes. 

A splendid cleansing gargle is half peroxide 
and half water, used every two hours. Another 
gargle which is also a good spray for children 
who cannot gargle well, and especially where 
there is much pain in the throat and the infec- 
tion has progressed so that the breath is foul, 
is: twenty drops of carbolic acid in one-half 
glass of warm water gargled or sprayed every 
two or three hours. This is particularly valuable 
in case of white spots on the tonsils and a bad 
breath as from decomposing matter. 

During an attack of tonsillitis the diet must be 
limited to easily swallowed foods, liquids and 
semi-liquids. For nursing babies the milk should 
be reduced one-half. 

The child should be isolated from others, kept 
in a warm well ventilated room, and protected 
from all exposure, as an infection in the throat 
can easily spread down the bronchial tubes result- 
ing in severe bronchitis or pneumonia. 

Boil all milk for family use during an attack 
or epidemic of tonsillitis. 

STREPTOCOCCUS SORE THROAT 

This type of sore throat at times becomes epi- 
demic. The false membrane forms over part or 



128 DISEASES OF INFANCY 

the entire throat, is very contagious and the 
disease is often fatal. It has been spread in con- 
taminated milk. The child with streptococcus 
sore throat is more acutely ill, with high fever 
and greater prostration, than in simple 
tonsillitis. 

Medical attention is always advisable in ton- 
sillitis and urgent in this type of sore throat. As 
the poisons are very liable to affect the kidneys, 
the physician will prescribe a diuretic to keep 
them active. 

Hot salt irrigations of the throat are especially 
valuable here followed by the spray of carbolic 
acid solution. 

Twice a day until the child is well it is very 
beneficial to introduce into the bowel a pint of 
warm water containing a teaspoonful of bicar- 
bonate or baking soda, dissolved. Give this 
enema with the child lying on his left side and 
give it slowly so that it will be retained and 
absorbed from the bowel. This baking soda 
enema will act to stimulate the kidneys and helps 
carry the poisons out of the system through the 
urine. 

.The bowels must be kept open. The sick-room 
discipline must be rigidly enforced and the quar- 
antine kept up. One member of the family can 
act as nurse unless a trained nurse can be 
engaged. At any signs of ear trouble notify the 
physician for there is always danger of a middle- 



TONSILS AND ADENOID GROWTHS 129 

ear infection from the poisons in the throat. 
(See Inflammation of the Ear.) 

QUINSY SOKE THKOAT 

This is peri-tonsillar abscess, an abscess around 
one of the tonsils, not in it. The symptoms are 
acute illness with chill, high fever and great pain 
in the throat, greater on one side. Swallowing 
may be almost impossible, the muscles of the 
neck will be very sore and the child will hold the 
head rigidly. The swelling around the tonsil 
becomes so great that the jaw is opened with 
difficulty. Upon making an examination one 
tonsil can be seen pushed well out into the middle 
of the throat, with the surrounding tissues 
appearing very red and puffy. 

Your physician must make an incision in the 
abscess and allow the pus to escape. If it is 
allowed to go until it ruptures, too much poison 
gets into the system and the spontaneous rupture 
heals so badly that it is often necessary to make 
an incision afterward before the throat will heal 
properly. 

Until the abscess is opened keep the bowels 
moving freely and clean the throat with irriga- 
tions of hot salt solution as directed for tonsillitis. 
The throat is generally too painful for gargles. 
Sips of cold milk are all that can be swallowed. 
Pieces of ice held in the mouth will temporarily 
relieve the pain. 



130 DISEASES OF INFANCY 



ADENOID GROWTHS 



We have discussed the formation of adenoid 
growths and the danger from infection under 
Tonsils. The removal of adenoid growths is an 
operation fraught with little or no danger. In 
babies no anesthetic is needed. In older children 
the removal takes a few seconds and the child 
is just put under the influence of the anesthetic. 
The operation is so simple that it should not be 
put off for a day when the adenoids begin causing 
trouble; it can be done at home and as a rule 
the child allowed up next day. 

At the first signs of mouth-breathing and when 
the baby begins to nurse with difficulty the back 
of the nose should be carefully examined for 
adenoids; also whenever there is a tendency to 
colds, running nose or earache. 

In thousands of cases in our public schools, 
children who have been backward, dull and 
oftentimes unmanageable, have become, after the 
removal of adenoid growths, as alert and pro- 
gressive as their fellow school-matQs. And a sur- 
prising improvement in the physical condition 
accompanies the advance in mentality. 

There are many serious consequences from 
adenoid growths. The adenoids become swollen, 
inflamed and diseased by bacteria. They may so 
block the nose that the child is compelled to 
breathe almost entirely through the mouth dur- 



TONSILS AND ADENOID GROWTHS 131 

ing the day and wholly through the mouth at 
night. The partial blocking of the nose inter- 
feres with speech, making it difficult to pro- 
nounce many words, especially those contain- 
ing the letters n and m. The mouth breath- 
ing causes the chin to drop and gives the face 
the characteristic long stupid expression known 
as the " adenoid face." 

There is almost always a chronic discharge 
from the nostrils, even when the adenoids are not 
large enough to cause mouth-breathing. The dis- 
charge is worse in winter and gives the impres- 
sion that the child is having repeated colds. 
Chronic cough caused by the secretion trickling 
down the throat often accompanies this condition. 

The difficulty in breathing limits the air supply 
and this, with the poison constantly seeping into 
the system, causes an under-developed body, con- 
tracted chest, a sluggish mind with pale face and 
heavy expression in the eyes, listlessness, nasal 
voice and under-developed chin, oftentimes prom- 
inent and crooked upper teeth and ear-trouble. 
In fact most of the ear trouble in children, except- 
ing that resulting from scarlet fever, measles 
and the other acute infectious diseases, is due 
to adenoid growths. These may even grow over 
the opening of the Eustachian tubes leading from 
the throat to the middle-ear, causing pain, dis- 
charge, "a running ear," and deafness. When 
adenoids cause ear trouble the child should be 



132 DISEASES OF INFANCY 

taken to an ear specialist. (See Inflammation of 
the Ear.) 

Children with adenoids, as a rule have less 
physical resistance than normal and are suscepti- 
ble to all the inter-current diseases. Investiga- 
tions in the schools of some of our larger cities 
have shown that the "adenoid child" spends over 
nine years in the eight elementary grades. 






CHAPTER XIII 
BRONCHITIS 

Children who suffer from chronically infected 
tonsils, adenoids or repeated colds eventually 
have some form of bronchitis. It is very preva- 
lent during the winter and spring months. 

The bacteria which lodge in the throat under 
these conditions soon find their way down into 
the bronchial tubes and set up an inflammation 
on the delicate membrane lining them. It becomes 
red, swollen, and like the mucous membrane 
lining the nose in case of acute cold, it throws 
out a great deal of mucous. This condition is 
bronchitis. 

Children who are careless about running out- 
doors in cold weather without additional clothing 
or rubbers or overshoes to keep the feet dry, 
are the ones most liable to attacks of acute 
bronchitis. 

During or following an attack of measles, 
whooping-cough, scarlet fever or other acute 
infectious disease, there is almost invariably 
some irritation of the bronchial tubes persisting 
for many weeks. And bronchitis is always pres- 
ent in tuberculosis. 

133 



134 DISEASES OF INFANCY 

Coughing in the face of another, close contact 
of any kind, such as sleeping in the same bed, 
will spread the infection. Eepeated attacks soon 
develop into a persistent and chronic form. The 
child below weight, thin, pale and stoop-shoul- 
dered is very liable to repeated attacks of bron- 
chitis and to the chronic type. This is well illus- 
trated in the richitic child; he always has bron- 
chitis. 

Children of rheumatic parentage will contract 
bronchitis without catching cold or being exposed 
to damp weather and their cases are often very 
baffling. The child's daily life and diet must be 
carefully regulated. He should have meat only 
two or three times a week; never candy, and 
sugar on foods in very limited amounts. This 
type of child usually suffers more or less from 
eczema, and it is a strange fact that this child 
rarely has fever with bronchitis. 

The usual case begins with cough and fever. 
The breathing may be a little rapid, twenty-eight 
to thirty ; but not so rapid as in pneumonia. The 
cough is aggravated, usually worse at night. In 
the baby the cough may be so severe throughout 
the day as to interfere with nursing. It is dry 
and hard in the beginning; sometimes severe 
enough to cause vomiting. The fever is not high, 
usually 99i/ 2 ° to 102° F. 

Properly treated from the start the attack 
will last no longer than a week. Without proper 



BRONCHITIS 135 

treatment bronchitis easily runs into pneumonia 
with high fever, above 103° or 104°, and rapid 
breathing of forty times a minute or oftener. 

A child with simple acute bronchitis, running 
a moderate fever of 101° or 102° will suddenly 
develop a high temperature if inflammation starts 
in the middle-ear. In babies this symptom is 
evidenced by the high fever, rolling the head 
from side to side, drawing up the arms and legs 
as in colic, and a piercing cry or a moan. 

THE TKEATMENT 

Put the child to bed and keep the room temper- 
ature at 70° F., as directed in the first chapter. 
A child who has a little fever, if allowed up is 
exposed to draughts, easily takes more cold and 
this may be all that is necessary to bring on 
pneumonia. Don't carry the baby about, bundled 
up, or load the sick child down with heavy bed- 
ding for fear of catching cold. This exhausts 
the body. At night when the room temperature is 
lowered put on extra covering and a warm cap 
over the head. During the day the usual bed- 
clothes and night-gown are sufficient. 

The first and best treatment is the big mus- 
tard plaster over the entire chest and back. Use 
one part mustard and three parts flour. Cover 
the chest well and leave on until the skin begins 
to turn pink, then apply olive oil or vaseline over 
the skin. Use fresh mustard plasters three times 



136 DISEASES OF INFANCY 

a day, without burning the skin. If this propor- 
tion of mustard is too strong, use more flour. 

The next treatment which gives most relief 
is inhalation of steam from the tea-kettle or 
croup kettle. Put ten drops of creosote in the 
kettle of water; make a tent over the crib or 
bed with a sheet and let your child breathe the 
steam for twenty or thirty minutes, letting a 
little fresh air under the sheet occasionally. 
Repeat this four or five times a day. It rapidly 
allays the inflammation and stops the cough. 

Give a good cathartic at once and keep the 
bowels open freely, using an enema if needed. 

Allow the baby to nurse only half as long, 
give an ounce of boiled water before each nurs- 
ing and three or four ounces between. Put a 
pinch of baking soda in the water. With the 
bottle-baby, cut the milk down one-half, adding 
boiled water to make up the difference. During 
the acute part of the attack older children should 
have milk, gruel, strained vegetable soup, mut- 
ton and chicken broth and junket. When fever 
and cough have subsided return to the regular 
diet, as the child has not been seriously sick for 
a long period the digestion can readily take care 
of the normal amount of food. Keep the child 
in bed for three or four days after the fever has 
disappeared to guard against fresh cold. 

After the acute stage the physician will pre- 
scribe an expectorant as it is important to raise 



BRONCHITIS 137 

the mucous and secretion from the bronchial 
tubes. Tartar emetic combined with ipecac, in 
small doses such as recommended in the treat- 
ment of bronchial pneumonia is excellent for 
this purpose. 

Chronic bronchitis is often overcome by a win- 
ter spent in a high dry climate, such as found 
in parts of Colorado, Arizona, New Mexico and 
California. Every effort should be made to build 
up the general health and resistance. Infected 
tonsils and adenoids should be removed and the 
teeth taken care of. There should be good nour- 
ishing food, long hours of rest, lots of fresh air 
and outdoor sleeping if possible. Cod-liver oil 
after each meal is a splendid tonic for these 
cases. " Treat the child" and not the bronchitis. 
He should not go to school, unless an open-air 
school is available, until the disease has been 
entirely stamped out. 



CHAPTER XIV 
PNEUMONIA 

Pneumonia attacks the young with great fre- 
quency and its tendency is to follow influenza 
or a hard cold. It is caused usually by the 
pneumococcus germ, which attacks the lungs; 
sometimes by other bacilli, including the grippe 
germ. 

The lungs divide into five lobes, three on the 
right and two on the- left side. These lobes are 
composed of light spongy tissue filled with air 
cells. When attacked by germs they become 
inflamed, the air cells fill with blood and mucous 
from the inflammation and air cannot get into 
them. Pneumonia may involve a whole lobe, the 
entire lung, or only small patches of one lobe. 

There are two types* of pneumonia, lobar and 
bronchial. Lobar pneumonia is the case where 
the whole lobe becomes solidified. Bronchial 
pneumonia is the case where patches of the infec- 
tion occur throughout the lungs at the. ends of 
the bronchial tubes. 

"When we breath air it goes first through the 
trachea which divides into two large bronchial 

138 



PNEUMONIA 139 

tubes, one passing to the right, the other to the 
left lung. These two branches divide and sub- 
divide like the branches and twigs of a tree. 
Thousands of these twigs permeate to remote 
corners of the lung, opening into the myriads of 
air cells carrying the air to every part of the 
lungs. . 

Fitting snugly over every part of the lung is 
the smooth lining membrane called the pleura, 
which is in two layers, one lining the inside of 
the chest and the other covering smoothly and 
firmly the five lobes of the lungs. These two 
smooth surfaces glide easily over one another 
as the lungs expand or contract in breathing. 
When this outside lining is affected, as it usually 
is in pneumonia, the sharp pain in the chest ia 
caused by the two layers of the inflamed pleurg 
rubbing against each other. This condition we 
know as pleurisy. 

When we have lobar pneumonia, a part or a 
whole lobe or maybe two lobes become inflamed, 
sometimes involving the whole lung, and the air 
cells fill with mucous and blood from the inflam- 
mation so that the air cannot get into them. 
Thus there is a possibility of actual death from 
suffocation. And the extra effort of the heart 
to pump the blood into the congested lung puts 
it under great strain. x Therefore the sick child 
must be 'kept quiet and comfortable so that his 
heart will hold up under the attack. 



140 DISEASES OF INFANCY 

When we have branchial pneumonia, the 
patches of inflammation occur at the ends of the 
bronchial tubes. There may be a few or many, 
and they may be in one lung or distributed in 
spots over both lungs. 

Thus air gets into part of the lung, but is 
shut off from the inflamed parts. When the 
mucous and blood is entirely emptied from the 
cells by being coughed up, the cells return to 
normal, the air gets in as usual and the attack 
is over but naturally the tissue which has under- 
gone this attack of inflammation is not as strong 
as it was and time is required to build up sound, 
germ-resisting tissue again. 

In the young, lobar pneumonia usually attacks 
the strong, vigorous child and just the reverse 
is true of bronchial pneumonia. 

Pneumonia comes on suddenly, often with a 
chill, and there may be cough, but there is 
always fever and rapid breathing ranging from 
forty to sixty times a minute, and the child is 
prostrated and acutely sick. While the child 
may vomit, lie in a stupor or even have a con- 
vulsion, these symptoms mark the beginning of 
many other diseases so that they are not typical 
signs of pneumonia to the mother. It is the 
rapid breathing, with fast pulse and fever which 
may vary from 98%° to 105° F., that leaves 
little doubt of the true nature of the disease. 

In the lobar type the crisis usually occurs 



PNEUMONIA 141 

between the fifth and ninth days, occasionally 
extending to the eleventh or fifteenth day, then 
the temperature drops to normal and the patient 
rapidly gets better. If the crisis is delayed 
longer than the ninth day, it means a serious 
infection, and the outlook for recovery becomes 
grave. 

THE TKEATMENT 

At the first evidence of serious illness the 
physician should be called, and when it is not 
possible to have a good regular nurse, the mother 
must follow carefully her physician's instruc- 
tions. The following suggestions are those which 
experience has taught will give the best results 
in the care of pneumonia and every mother of 
a family will do well to acquaint herself with 
them. 

In the first place, let us remember that pneu- 
monia is going to drain the child's powers of 
endurance and we must do everything possible 
to keep his physical strength in reserve. The 
more he expends it in moving about and fretting, 
or the more he has to resist changes in tempera- 
ture, draughts and the like, the less he will have 
of energy to combat the disease in its crisis. 
And any tax put upon the stomach by over- 
feeding, causing gas which may press up against 
the heart, or any tendency to constipation, will 
greatly lower the child's vitality and give him 



142 DISEASES OF INFANCY 

Jess resistance for liis fight to get rid of . the 
pneumonia infection. 

It has been demonstrated beyond any doubt 
that fresh air treatment is the great saving 
measure. The air must be kept fresh day and 
night, but this must be accomplished without 
draughts or changes in temperature. With 
plenty of fresh air breathing is not so rapid and 
the heart action is stronger, the child is more 
comfortable and sleeps better. In cold weather 
the heat should be left on so that the temperature 
of the room remains even at 60° to 65° F. day 
and night, with fresh air coming in and an outlet 
for the stale air. A warm night-gown and cap 
to protect the head should be used and the bed- 
ding should be warm but light-weight so as not 
to use up any of the child's strength, as would 
be done by heavy quilts loading down the limbs. 

The child and baby runs much less risk of 
taking cold when kept in his bed or crib than 
when held in the mother's arms or lap. 

The sick room must be kept quiet. It is na 
place for visitors or anxious neighbors. Their 
presence annoys the child and takes away some 
strength that may be needed in a critical strug- 
gle for life. 

At the first signs of illness the bowels should 
be cleaned out and must be kept active, moving 
thoroughly once a day. If it is necessary, an 
enema must be given to accomplish this. 



PNEUMONIA 143 

Small doses of calomel act well in pneumonia. 
For children under three years, one-tenth of a 
grain, and after that age, one-sixth of a grain 
every hour, for three or four hours, and repeated 
every second or third day. This helps to carry 
off a great deal of the poison through the bowels, 
with the result that the fever is kept lower. 

In the beginning, when there is pain in the 
chest, a mustard plaster, one part mustard and 
three parts flour, should be placed all over the 
pain areas, and left on until the skin starts to 
redden. This treatment should be repeated in 
four or five hours. After three applications, the 
quantity of mustard should be reduced and the 
flour increased. 

In managing a fever> remember that some chil- 
dren can have a high fever without seeming 
inconvenience, while others show great restless- 
ness, discomfort, and are thrown into delirium 
if the fever reaches 103°. However, in any case, 
when the fever goes above 103°, the pulse is apt 
to become so rapid that excessive work is placed 
on the heart. Such a condition is dangerous. 

To reduce the fever no method can be recom- 
mended that is better than the cool sponge, 
repeated at intervals of from two to four hours. 
Only part of the body should be sponged at a 
time, the rest being kept covered, and the water 
should not shock the skin. It can be gradually 
made cooler. This is the safest method to pur- 



144 DISEASES OF INFANCY 

sue for the mother who has not had nursing 
experience. 

To a quart of water add a tablespoonful of 
salt, or add eight ounces of alcohol and have the 
water at a temperature of 70° F. Sponge for ten 
or fifteen minutes. Do not dry the skin but let 
the water evaporate and heat will be thrown off 
in the process. 

In all cases of pneumonia the digestive power 
during the first few days of the attack or until 
the crisis is past, is greatly diminished, and the 
usual milk feeding or nursing must be reduced 
about one-half, giving water to make up for the 
amount of milk omitted. Often the regular milk 
cannot be taken and peptonized milk or condensed 
milk will have to be used because it digests more 
easily. In the nursing baby, give water from a 
nursing bottle before nursing and let the baby 
nurse only half as long. 

For children during the run-about age, broth 
and thick gruels, half milk and half gruel, are 
the proper diet. 

In cases of collapse it is often impossible to 
get the child to take anything by the mouth, and 
then rectal feeding is necessary as nourishment 
must be given. Liquid peptonoids or skimmed 
milk which has been peptonized are suitable for 
rectal feeding and are described in the Appen- 
dix. If necessary your physician will attend to 
giving a little stimulant. 



PNEUMONIA 145 

The rubbing of olive oil or unsalted lard into 
the skin is recommended as the oil is absorbed 
freely and helps to nourish the body. All medi- 
cine should be prescribed by your physician. 

Guard against overloading the stomach. The 
digestion is weak and an overloaded stomach 
is one of the greatest dangers in pneumonia 
because it may suddenly dilate, pressing upon 
the heart and causing collapse and death. 

Fortunately children pass through pneumonia 
much better than adults. After the crisis and 
when the child is on the road to recovery, the 
mother must remember that the illness has been 
very acute and has taken a tremendous amount 
of reserve power. Consequently a long period 
of rest is required. The child should be kept 
quiet and not allowed to be up and about and 
excited or exposed because a fresh cold is easily 
taken and a relapse is apt to prove fatal. 
And the child should return to the usual diet 
gradually. Always keep close watch of the bowels; 
to see that they move thoroughly each day, and 
if they fail, never omit an enema before night. 
It takes some time to get the lungs strong again 
and the child should have plenty of fresh air- 
day and night but should be carefully guarded 
against draughts and never allowed out in the 
cold without putting on sufficient extra clothing,, 
with especial attention to overshoes to keep the- 
feet dry and warm in cold or wet weather. 



CHAPTER XV 
PLEURISY 

Pleurisy is an inflammation of the pleura, the 
covering of the lungs. It is usually associated 
with pneumonia, tuberculosis or some other dis- 
ease of the respiratory organs. Rarely it occurs 
alone. The symptoms are, ' ' a stitch in the side, ' ? 
short rapid breaths as the pain increases and 
usually a sharp, hard cough with some fever 
which may run up to 102° or 103° but which is 
usually lower. 

Treatment. — Put the child to bed, give a 
cathartic and cover the chest where the pain is 
most severe with a mustard poultice, one-third 
mustard and two-thirds flour; or one part mus- 
tard and eight parts flaxseed. Put it on hot, 
leave for ten or fifteen minutes or until the skin 
is flushed, cover the reddened skin with vaseline 
or oil and repeat in seven or eight hours. Poul- 
tices are very effective if used the first day or 
two of pleurisy, but are of little value later. 
It is then best to strap the painful side of the 
chest with wide pieces of adhesive plaster, fas- 
tened in back as far as the spine, drawn tightly 

146 



PLEURISY 147 

over the chest during a complete expiration and 
fastened as far forward as the center of the 
chest. Use four or five strips, overlapping each 
other. These plasters fastened on snugly when 
the air is expelled from the lungs hold the side 
quieter, keep the lung from filling full of air 
and thus prevent the layers of the pleura from 
rubbing against each other. It is this friction 
which causes the pain in pleurisy. 

At the beginning of an attack, as soon as the 
child is in bed, it is a good plan to induce per- 
spiration by giving fifteen drops of tincture of 
aconite in one-half glass of water, taking one 
teaspoonful of this every hour for ten doses for 
a child under five. For older children, use twenty 
drops in one-half glass of water. The child 
must be kept in bed until the fever and pain 
have disappeared. 

In pleurisy accompanying pneumonia or tuber- 
culosis as a rule the child complains little of 
pain in the chest. If the pain is annoying use the 
mustard or flaxseed poultice or paint the pain- 
ful part every second day with tincture of iodine. 

Fluid may form in the chest and interfere with 
breathing, or if on the left side, with the action 
of the heart, to such an extent that your phy- 
sician will have to insert a needle and draw off 
some of it. If there is not a great amount, and 
if left alone, it usually absorbs as the child 
improves. 



148 DISEASES OF INFANCY 

Pus in the Chest {Empyema). — This is a pur- 
ulent pleurisy, and one of the most unfortunate 
complications that follow pneumonia. The child 
will usually have passed the crisis of pneumonia, 
with the temperature running normal for three 
or four days, when the mother will be chagrined 
to find the temperature rising again, the child 
feeling very weak, sweating exhaustingly and 
with face pale and drawn. Upon examination 
the physician finds that pus has formed in the 
chest. It is then necessary to make an incision 
in the chest wall to allow the pus to escape- 
Little drainage tubes must be put in the incision, 
and the dressings which become soaked with pus, 
frequently changed. As the pus drains out, pulse 
and temperature come back to normal and the 
side gradually heals. This may take two or three 
weeks or as many months. The child will be 
very exhausted and needs diligent nursing and 
nourishing, easily digested foods to keep up the 
strength until the pus has all drained out and 
until the chest is completely healed. 



CHAPTER XVI 
ASTHMA AND HAY FEVER 

There is a type of asthma found in children 
who are repeatedly catching cold and which is 
one of the symptoms of acute bronchitis. It 
disappears with the correction of the bronchitis. 

The true asthma starts suddenly and as far 
as the mother can see there are no signs of 
bronchial disturbance although these asthmatic 
attacks leave a mild chronic inflammation of the 
bronchial tubes in nearly all children. 

True asthma has many causes. Some of our 
best authorities believe that it comes in many 
cases from the indigestion of an article of food 
that the child does not tolerate well. In some 
cases it is meat, in others eggs or sugar or 
cream. "With some children eggs cause illness 
and vomiting and bring on an attack of hives as 
well as asthma. Meat, especially red meat, and 
sugar in some cause severe attacks of asthma. 
And these same children often suffer from eczema 
and usually have some rheumatic family history. 
Some children break out with eczema from the 
cream in cow's milk and as they grow older, if 

149 



150 DISEASES OF INFANCY 

cream is still taken above their limit of tolerance 
they have attacks of asthma. 

The distressing symptoms are familiar to all: 
the labored attempt at breathing in and breath- 
ing out, the wheezing sound. The pale, drawn 
face, sometimes blue with the exertion of breath- 
ing, the perspiration standing out around the 
head and neck and often several sharp coughing 
spells which add to the distress. The child has 
to be propped up in bed with pillows, the head 
thrown back and the hands braced against the 
mattress in order to get breath. The breathing 
may be so loud that it can be heard across the 
house. 

The attack of true asthma usually comes on 
suddenly during the night, and immediately after 
a hearty meal, or with sudden exposure to a 
cold draught or high wind. Great nervous excite- 
ment brings on an attack in some children, and 
the odor of certain flowers or animals, espe- 
cially cats or horses, or riding behind a horse 
will cause the symptoms. 

Treatment. — Each case must be studied indi- 
vidually to find the possible cause. If it is the 
odor of flowers or animals the special ones that 
provoke the trouble must be singled out and 
avoided. Experiments must be made with the 
diet, eliminating different foods to find the one 
responsible for the attacks. If the child's imme- 
diate ancestors suffered from rheumatism or 



ASTHMA AND HAY FEVER 151 

gout, center your attention on the sugar and 
meat. Allow meat, poultry and fish only two or 
three times a week, or eliminate them entirely 
for a time and cut out beef entirely. Give no 
candy and only the scantiest allowance of sugar, 
not over three teaspoonfuls a day on or in all the 
foods. 

It is permissible to use the proper proportions 
of green vegetables (omitting navy beans), 
plenty of cooked and suitable raw fruits, whole- 
wheat bread, thoroughly cooked oatmeal and 
other cereals, cottage cheese, some American 
cheese, buttermilk, also milk and eggs if you 
have found by previous experiments that these 
are not the offending foods. Some potato can 
be given daily if well-baked or boiled, but never 
if fried or underdone. Omit all fried foods. 
Give skimmed milk until you are satisfied that 
cream is not the cause of the attacks. Butter 
is well taken as a rule. 

The child with rheumatic ancestors who has 
given evidence by outbreaks of eczema and 
attacks of asthma, of inheriting this tendency, 
should receive the same internal treatment over 
a long period of time as recommended for rheu- 
matism. Sodium salicylate given alone or com- 
bined with bicarbonate of soda should be given 
in the following doses: two grains of each for 
a child under three, stirred together in a little 
milk after each meal; three grains of each for 



152 DISEASES OF INFANCY 

a child between three and six; five grains of 
•each for a child between six and twelve years. 
Give for ten consecutive days, with a rest for 
one week and a renewal of the daily dose for 
ten days more and so on for a period of two or 
three months. 

The asthmatic child must never be consti- 
pated. Reducing the allowance of meat helps 
avert this condition. Use the mineral oils at 
bed-time, as large a dose as nesessary as it has 
no harmful affect as none of the oil is absorbed. 
Suspicious tonsils and adenoids must . come 
out. Any interference with breathing due to 
obstruction in the nose must be corrected by a 
specialist. 

To relieve the spasms use inhalations of 
steam from the tea-kettle or croup-kettle as 
directed for Bronchitis, using the creosote or ten 
or fifteen drops of oil of eucalyptus in the boil- 
ing water. Be careful not to burn the child's 
skin with the steam. 

Your physician will recommend other special 
preparations which can be burned in the room, 
or inhaled from a sponge or handkerchief. Mus- 
tard plasters can be applied to the front and 
back of the chest to relieve the congestion. 

The asthmatic child should not go to school 
until the condition has been corrected; but 
should live in the open air as much as possible 
and guarded against all excitement. The even- 



ASTHMA AND HAY FEVER 15S 

ing meal should always be light. A sunny dry 
climate works wonders in some cases but the 
child must remain for several months to receive 
permanent benefit. The diet regulations also 
must be persisted in over a long period before 
permanent results can be expected. 

HAY-FEVEB 

Hay-fever is seen only in older children. It 
is due to irritation of the mucous membrane of 
the nose by the pollens of timothy, rag-weed, 
golden-rod and other plants and the odor of 
roses, violets and peaches, and products given 
off from the hair of cats, dogs and other ani- 
mals, especially horses. 

The attacks usually come on in the fall, par- 
ticularly when the fever is caused by the pollen 
from weeds. They start with symptoms like 
that of an acute cold; redness, itching and dis- 
charge from the eyes; sneezing and running of 
the nose with congestion of the mucous mem- 
brane of the nose and consequent difficulty of 
breathing through the nostrils. The symptoms 
are very distressing but the disease is not dan- 
gerous or contagious. When it comes on year 
after year asthma may develop. 

Little can be done to relieve the attacks other 
than the use of antiseptic sprays, such as 
Dobell's solution, and at times very weak solu- 
tions of Adrenalin used as a spray. Eucalyptus 



154 DISEASES OF INFANCY 

and menthol in a one per cent solution put up 
in sterile white vaseline, snuffed up the nose or 
applied gently on the end of the finger will tem- 
porarily relieve the congestion and facilitate 
breathing. Children can be benefited by a 
change of climate away from localities where 
hay- fever prevails. 

Some success is now being had in the use of 
serums made from pollens and injected under 
the skin, beginning the treatment several weeks 
before the attack is due to come on. This has 
in some cases prevented the annual attacks 
entirely and in others relieved their severity. 
Vaccination is now made with serum from vari- 
ous pollens to determine which is the cause of 
the hay-fever in each individual case, and then 
serum made from the pollen that is responsible 
for the hay-fever is injected. 






CHAPTEE XVII 
TUBERCULOSIS 

If tuberculosis were recognized and properly 
cared for in childhood a vast multitude would 
escape it in adult life. It is so commonly over- 
looked in the child because every other possible 
cause will be ascribed to the run-down condition 
that attends it, despite conclusive proof that 
children are particularly susceptible to the dis- 
ease. Thousands annually contract tuberculosis 
in their early years but because they have con- 
siderable rest and outdoor life with little of the 
strain of work the process does not advance for 
years. 

The young child thrown in contact daily with 
some tubercular member of the family rarely 
escapes the disease. Careless coughing or spit- 
ting and failure to destroy the sputum, the 
germs in which soon dry to be breathed into the 
lungs through the air, are an ever-present cause. 

Tubercular germs readily lodge in the ade- 
noids and tonsils, particularly when these 
organs are inflamed or enlarged. They are also 
swallowed in the secretions from the infected 

155 



156 DISEASES OF INFANCY 

tonsils or in milk from a tubercular cow or 
handled by a dairyman suffering from the 
disease. 

The utmost cleanliness should be observed 
about the bottles and nipples used by babies, 
and with spoons, dishes and other such articles. 
Boiling water should be used for washing all 
articles on which germs might be carried. Chil- 
dren should never play on dirty floors and car- 
pets, or put toys or other objects in the mouth 
because the tubercular germ can live in the dust 
that may fasten to such objects. A most unfor- 
tunate habit is the promiscuous kissing of babies 
on the mouth. A child born into a family where 
there are tubercular parents should if possible 
be removed to the home of some relatives where 
the disease does not exist, to live there for the 
first five years of his life. In this way he will 
escape the disease. 

It is most dangerous to allow the baby to 
nurse from a tubercular mother and any tuber- 
cular member of the household who is obliged 
to remain where there are children should have 
a separate room, should use his or her own 
dishes, drinking cups and spoons, which should 
be thrust into boiling water immediately after 
use, and all sputum should be faithfully 
destroyed. The milk the child drinks, unless it 
is certified or pastuerized, must be boiled for 
three minutes. No one should occupy the room 



TUBERCULOSIS 157 

of the tubercular sufferer until it has been thor- 
oughly fumigated according to the rules laid 
down in the first chapter of this book. 

There are different types of tuberculosis in 
children which must be considered briefly. In 
babies and young children there occurs what 
we call miliary tuberculosis, sometimes referred 
to as the typhoid type of tuberculosis. This is 
always fatal. 

The child begins to waste away, gets weaker 
day by day, loses appetite, has fever which will 
run up and down somewhat as in typhoid fever. 
No cause can be discovered, the disease lasts 
as a rule but a few weeks, many times termi- 
nating by an affection of the brain, meningitis 
developing. Physicians stand helpless in the 
presence of this type of tuberculosis. 

Tuberculosis may affect the intestines. The 
child usually has a little fever, although this is 
not always present. The appetite is poor, there 
may be diarrhea, very often alternated with 
constipation. The abdomen is usually distended 
with gas. Tuberculosis is determined only by 
careful laboratory examination of the feces for 
the tubercular germ, and by giving the tuber- 
culin test. 

Tuberculosis may extend to the covering of 
the intestines and there develop tubercular peri- 
tonitis. The abdomen then is greatly distended 
and tender when pressed upon. Irregular fever 



158 DISEASES OF INFANCY 

exists, as a rule higher in the afternoon and 
evening than in the morning. The breath comes 
more rapidly because the distended abdomen 
pushes up against the diaphragm. 

The bones may be affected, especially the 
joints or the spine. It will start in one joint, 
very commonly the hip joint, or in the knees 
or elbows. Probably the first sign the mother 
notices is that the joint is swollen and the child 
favors it, moving it very little. If in the hip 
or knee there will be a limp and quite a little 
swelling around the knee when that joint is 
affected. When the hip is affected the child may 
limp for several days and then appear to be all 
right, only to have the limp return. As the 
disease progresses the child will hold the mus- 
cles of the hip rigid. If laid flat on his back he 
holds the muscles of that hip so stifly that he 
will raise that side from the floor resting all 
his weight on the other hip. Any attempt to 
move the hip joint causes a great deal of pain. 

After a blow, fall or other injury to the spine, 
when the child is a little run down and the tuber- 
culosis germs are alive somewhere in the sys- 
tem they readily locate in the part that is 
injured. One or two of the vertebrae become 
partially destroyed and the spine curves at that 
point. Before this occurs, when the spine is 
first attacked by the germs, because of the stiff- 
ness the child holds it rigid and when stooping 



TUBERCULOSIS 159 

will bend the hips and knees, not the spine. If 
the tubercular germs are in the upper end of 
the spine, the neck will be held stiffly, the child 
refusing to turn it from side to sidk. When the 
child bends forward, undresaed, the whole spine 
appears as rigid as a ramrod. When you feel 
gradually down the spine, pressing in sharply 
and forcibly with the thumb over each vertebra, 
if you come to one where the disease has located 
the child winces with pain as you press upon it. 
In the normal spine there is no such extreme 
tenderness. 

After the third year, tuberculosis very com- 
monly starts in the glands on each side of the 
neck, finding its way there from infected tonsils 
or adenoids. These glands enlarge, hurt when 
pressed with the fingers, and the entire chain of 
glands on each side of the neck may become 
involved. This condition has been commonly 
called scrofula; it is tuberculosis of the glands 
of the neck. (See illustration on page 121.) 

From the glands the infection rapidly travels 
down to the lungs, to the covering of the lungs 
or pleura and to the lymphatic glands in the 
chest. 

Tuberculosis, especially of the miliary or 
typhoid form, which we mentioned previously, 
may find its way to the coverings of the spinal 
cord and the brain and tubercular meningitis 
develops which is fatal. 



160 DISEASES OF INFANCY 

DETECTING TUBERCULOSIS 

All a physician's ingenuity is often taxed in 
detecting tuberculosis in young children. The 
disease may be generalized, involving many 
organs of the body, and may not have any one 
definite location in the lungs which can be dis- 
covered by examining the chest or by the X-ray. 

The baby or child who remains below weight, 
is pale and thin, with poor appetite, often run- 
ning a little fever late in the day, and sweating 
at night at times — when the common causes of 
these symptoms have been removed — should 
always be considered a possible sufferer from 
tuberculosis. 

Wlien glands in the neck enlarge, look for 
the source of the trouble. These glands are 
very often tubercular and when they first appear 
swollen, treatment should be immediately begun. 
Repeated colds and attacks of bronchitis often 
mark the beginning of tuberculosis in children. 

As a final means of discovering tuberculosis 
in childhood we have the tuberculin test. Vari- 
ous methods are used, such as the injection of 
the tuberculin directly into the system, but more 
commonly the von Pirquet skin test is employed 
in children, and can readily be made by your 
physician. The test is positive in one who is 
a victim of this disease or in one who has had 
it. The only drawback to its use is with older 



TUBERCULOSIS 161 

children who may have had tuberculosis which 
has healed. The test does not indicate whether 
the disease has healed or not, and in the case 
of the child where the scars of tuberculosis have 
healed, the symptoms which gave rise to the 
examination may be due to some other cause. 
Nevertheless, when the child is ailing and the 
cause of the trouble cannot be determined, and 
the tuberculin skin test is made and found posi- 
tive, it means that that child should have a 
period of rest, nourishing food and fresh air 
until he has been built up and gotten strong 
and back to normal weight, because far too often 
is the trouble ascribed to something else when 
there is lying dormant a tubercular process 
which is ready to leap into activity the minute 
the slightest chance is offered, such as cold, 
pneumonia, grippe, measles or whooping cough. 
The child should be given the benefit of the sus- 
picion that there is some active tuberculosis still 
present even though the glands don't show it 
or the doctor's stethescope doesn't find it. 

Childhood is the time to c;ure the disease and 
it is not to be fooled along with, with excuses 
laid to every other possible cause. The child's 
days are not productive days; he doesn't have 
to work and three months or six months or a 
year's rest may mean a lifetime of good health 
and efficiency as against forced idleness during 
his productive years. 



162 DISEASES OF INFANCY 

In the treatment of tuberculosis there is no 
magic, there is no wonderful discovery which 
brings a cure overnight or in a few days or weeks. 
There are three essentials to a cure and they are 
rest, fresh air and good food. As a first step in 
the treatment of tuberculosis, especially where the 
glands are swollen, enlarged or infected tonsils 
must come out; enlarged adenoids must be 
removed; decayed or infected teeth put in order. 
Then you are ready to begin the treatment in 
earnest. Children with tuberculosis are usually 
running some fever. This may be only one-half 
a degree, a degree, or even more. It comes up 
in the afternoon or evening and will probably be 
down to or even below normal in the morning. 
On the other hand the child's vitality may be so 
low that the temperature remains below normal 
all day and this is just as significant a sign as 
though the temperature ran above normal with 
fever. 

These children must have rest. They should 
remain in a reclining position most of the time 
and in bed all of the time. Build a sleeping 
porch where the child can live outdoors day and 
night. Put up a tent in the yard, the sides of 
which can be rolled up. Take the temperature 
in the morning, at four o'clock in the afternoon 
and the last thing at night and keep a record of 
it. As the temperature returns to normal it is 
a sign that the child is improving. As long as 



TUBERCULOSIS 163 

it runs above normal, or below normal, the 
child should not be allowed out of bed to take 
any exercise. Don't be misled by the bettered 
appearance and let the child get up, for a half 
cure is as bad as no cure and the effort of it 
is wasted. The improvement will last only a 
few weeks or months and you will be dismayed 
by seeing your child again grow thin and pale 
with loss of appetite. 

No one can tell how long this rest will have 
to be kept up. It all depends upon how rapidly 
the individual child can overcome the infection 
and upon the advance of the disease at the 
time it is recognized and treatment started. 
Taken in time, in its beginning, tuberculosis is 
easily curable, with the exception of the miliary 
type which we have described. When a child is 
at rest all the vital forces are being conserved 
to fight the disease and as long as the child 
runs a temperature it means that the tuber- 
culosis is active, is not under control and has 
the best of the situation. This is also true when 
the temperature remains below normal all day. 

After the child has remained carefully resting 
until the temperature has returned to normal, 
the rest should be continued for six weeks 
longer. You can then allow the child to sit 
up a few minutes each day in a chair. If the 
temperature remains normal morning, afternoon 
and evening, he can take a few steps, going 



164 DISEASES OF INFANCY 

to the next room for example. Each day he can 
sit up a little longer. Do this slowly and grad- 
ually and if any temperature returns, it means 
that he must go back to bed and rest until it is 
normal again. A temperature may come up for 
just one day and not mean anything other than 
a little indigestion, but if it returns, coming up 
edch afternoon, it means that the child must 
have a longer period of rest. 

As the time is increased in which the child 
is allowed out of bed, until he is able to sit up 
the entire day, and he is able to take more steps 
and a short walk, the temperature and the pulse 
must be watched as carefully as when he was in 
bed. Because if he is found overdoing, making 
the pulse rapid and producing a little fever, all 
exercise must be immediately stopped. Con- 
tinuing to overdo will undo all that has been 
accomplished. 

This process of the gradual return to health 
is exceedingly slow, tedious and often very dis- 
couraging, but it is worth every ounce of effort 
you put into it because if conscientiously carried 
out a complete cure will result. In one great 
institution in England devoted to the treatment 
of tuberculosis you will find patients who have 
been in bed for weeks and months, some of 
whom are taking just a few steps daily, others 
taking a quarter-mile walk, others a mile or 
even two-mile walk, others almost completely 



TUBERCULOSIS 165 

cured, taking daily walks of five to seven miles, 
and others so completely recovered that they 
are breaking stone and building roads. These 
patients in the beginning were thin, emaciated, 
running a fever and with a discouraging out- 
look. 

THE DIET 

The diet in tuberculosis treatment is of great 
importance. Do not be misled by the old, stuff- 
ing idea common in the past and still advocated 
by some. A child in bed, without exercise, con- 
stantly stuffed with food, will have his digestion 
upset so that little or no food can be properly 
assimilated. Give three meals a day to the 
child over three years of age. Give these meals 
regularly. Let the diet be a general one. Well- 
cooked beef or lamb, roasted or broiled, should 
be given once a day. Eggs, if they do not cause 
biliousness, should be given once a day. Well- 
cooked cereals, especially oatmeal cooked three 
hours are very nourishing. As much butter as 
the child will eat should be served on the foods. 
Lots of fat is necessary, and butter is the most 
easily digested. Many children take olive oil 
well, a teaspoonful with each meal. The bread 
should be whole-wheat. All the well-cooked veg- 
etables except navy beans, and all the season- 
able fruits should be added to round out the 
diet. A glass of good rich creamy milk should 



166 DISEASES OF INFANCY 

be given with each meal. Do not give foods 
between meals, unless the child becomes very 
hungry and then a glass of milk is the best 
extra food. Do not give sweets between meals. 
But sugar is valuable in the treatment of tuber- 
culosis, and it can be served on appropriate 
foods, and one or two pieces of candy allowed 
with the meal. Taken with the meal it will not 
upset the digestion. 

Most of these children have a tendency to 
become constipated, while lying in bed. This 
must not be permitted, because it will defeat 
your object. A splendid practice is to use one 
of the mineral oils, such as liquid albolene, 
Interol or Nujol, a teaspoonful or tablespoonful 
at bedtime, according to the age of the child. 
You need not fear to give this as none of the 
oil is absorbed and its use can be continued 
over any period without harmful effects, it sim- 
ply lubricates the lining of the bowel, softens 
the movements, and does not have any of the 
depressing effects that follow the frequent use 
of cathartics. 

The use of medicines in the treatment of 
tuberculosis is of little value. Cod-liver oil for 
children who will take it well is very valuable 
as it supplies a good additional fat and helps 
build up the body. Iron tonics are necessary for 
many children who are anemic and have poor 
appetites. A suitable one will be prescribed 



TUBERCULOSIS 167 

by your physician. In children where the dis- 
ease has affected the glands, the syrup of the 
iodide of iron is a splendid measure. Fifteen 
or twenty drops are given in water after each 
meal for children of three to six; one-half tea- 
spoonful for older children. 

When tuberculosis has affected the joints, it 
is absolutely necessary that the joint be put 
completely at rest. Braces or casts will have 
to be used so that the joint cannot be moved 
until the tubercular process has healed. When 
the spine is affected, a brace must be provided 
to hold the spine perfectly still and in the early 
part of the treatment, if the disease has 
advanced to any extent, your physician may find 
it necessary to keep the child for a period com- 
pletely resting in bed. If tuberculosis of the 
joints or spine is neglected it calls for very rigid 
treatment later. The first signs which make 
you suspicious must not be overlooked because 
it is tuberculosis anywhere in the body taken 
in the beginning which is comparatively easy 

to handle. 

i 

THE SU^T TKEATMEXT 

The proper use of sunlight in the treatment 
should be more widely understood. A child 
with tuberculosis can be put out in the sunlight 
for several hours and the sun's rays directly 
on the body may produce a temperature which 



168 DISEASES OP INFANCY 

makes the process become active. If tlie child 
has been accustomed to the sun's rays, they 
can be used to great advantage in the treat- 
ment. Especially is this true where tuberculosis 
affects the bones or the joints. The sun's rays 
are very powerful and are able to set up chemi- 
cal changes in the body. Especially is this true 
with tubercular patients. 

If you have a porch where the direct rays of 
the sun fall, the proper method is to begin by 
first exposing just the patient's feet for about 
five minutes. The next day expose the feet for 
five minutes and up to the knee for five minutes. 
This gives the feet ten minutes the second day 
and up to the knees five minutes. The third day, 
expose the feet to the direct rays for five min- 
utes, then to the hips for five minutes. This 
makes fifteen minutes for the feet, ten for the 
legs up to the knees and five up to the hips. 
The fourth day, expose the back of the limbs, 
first the feet then the knees, then the hips, in 
the same way that you exposed the front of 
the limbs, exposing part each day. Then the 
lower part of the back is exposed five minutes 
including the lower limbs which have gradually 
become accustomed to the direct rays, and then 
the upper part of the back. Then allow the 
exposure over the abdomen for five minutes and 
the chest for five minutes, and then this time is 
lengthened to ten minutes. Expose the arms 



TUBERCULOSIS 169 

at the same time with the chest. In this way- 
day by day you gradually expose a little of the 
body more and more until the whole body is 
exposed to the sun for a period of about one 
hour each day. This time is slowly lengthened 
until in some sanitaria, in climates where the 
sun shines most of the day, patients in protected 
porches, remain with the direct rays of the sun 
on the entire surface of the body, the clothes 
being removed, for five and six hours. In the 
sun treatment the head must always be pro- 
tected from the direct rays by a hat or shade of 
some kind. Where joints are affected, the cast 
or brace is loosened and the direct rays of the 
sun are allowed on the joint after the patient 
has become thoroughly accustomed to the sun's 
rays. This will produce almost unbelievable 
results in affecting a cure. 

The use of tuberculin in the treatment of 
tuberculosis, especially in cases where the glands 
are affected, has given very good results when 
used carefully and in minute doses. This treat- 
ment can only be carried out by your physician. 



CHAPTER XVIII 
THE EYE AND EAR 

THE EYE 

Injuries. — In an external injury to the eyelid, 
if the skin is cut so that the edges do not come 
together, the wound must be sewed by a phy- 
sician. After a blow, if the lids swell and pain, 
cloths wrung out of warm lead-water should be 
applied and these frequently changed. If the 
skin has not been laid open but the lids have 
blackened and swelled, cloths wrung out of ice- 
water and frequently changed will help reduce 
the swelling. "When the swelling is very great, 
if possible, obtain a leech from your druggist 
to suck out the congested blood. 

Something in the Eye. — When a sliver of 
steel flies into the eye, being sharp, it usually 
penetrates some distance into the eye-ball and 
must be at once removed by a physician, a mag- 
net usually being necessary. When dirt or cin- 
ders get into the eye, roll the upper lid back 
over a pencil, the little finger or a match and 
pick out the particle with the end of a tooth- 
pick covered with a clean handkerchief. Have 

170 



THE EYE AND EAR 171 

the child look down when you roll the lid back 
and you will generally see the particle sticking 
under the upper lid. Then wash out the eye 
with boric acid solution to carry out any germ 
or infection that may have been on the dirt. 
Make the solution one level teaspoonful of boric 
acid crystals to one pint of water boiled five 
minutes and cooled. An eye-cup is useful in 
using the solution when washing out the eye not 
only for cinders and dirt but whenever the eye 
is inflamed or painful. The eye can also be 
irrigated by an eye-dropper, having the child or 
baby lie back, turning the head to one side and 
letting the boric acid solution flow into the eye 
from the nasal side. 

Infection. — Should an infection get into the 
eye and the eye or lids become inflamed, wash 
out the eye three or four times a day with the 
boric acid solution or one or two drops of 
twenty per cent argyrol. Argyrol is dark brown 
and for a few moments discolors the eye but 
it destroys the germ. 

Styes. — Styes form on the lids of the child 
who is suffering from eye-strain or who is run 
down. They start as inflammations at the roots 
of the eye-lashes and pus forms. When the 
swelling starts the development of , a stye can 
often be prevented if the inflamed lid is kept 
covered with sterile gauze or clean linen wrung 
out of boric acid solution as hot as can be 



172 DISEASES OF INFANCY 

borne and frequently changed. Applications 
of lead-water can be used in the same way. If 
pus has formed, the stye must be opened and 
the eye washed clean with the boric solution, 
using the eye-cup. This is done to prevent the 
pus from forming a conjunctivitis or inflamma- 
tion of the lids. 

Inflammation of the Eyelids. — The conjunc- 
tiva is the delicate membrane which lines the 
eyelids and also covers the eye-ball in front. 
An infection may get on this membrane from 
dirt, from rubbing with the fingers, from bad 
air, or accompanying some disease such as 
measles. An inflammation is immediately set 
up and the membrane becomes swollen, red and 
painful. The eye becomes sensitive to the light 
and there is usually a watery secretion. If this 
inflammation is allowed to continue pus may 
form and the discharge will become purulent. 
The lids will usually stick together in the 
morning. 

There are several kinds of conjunctivitis, or 
inflammation of the lids. The simple, common 
form is caused by some mild infection which 
gets in the eye, the eye becomes reddened, there 
is very little pain, and with the correct treat- 
ment promptly disappears. The more severe, 
contagious form is caused by a definite germ 
and is known as " pink-eye." This usually 
comes on in the spring or fall, is very conta- 



THE EYE AND EAR 173 

gious, and lasts several days, the eye being 
acutely inflammed and sensitive to light. There 
is considerable pain and watery discharge which 
readily subsides in a few days with correct 
treatment. Children with "pink-eye" should 
be kept out of school, away from other children 
and have the eye protected from the light by a 
shade. Another type of conjunctivitis comes on 
every spring in some children causing redness 
of the eye, and persistent pain and watery dis- 
charge which must be treated by an oculist. 

In the Neiv-born. — There are the severe 
inflammations such as occur in the eyes of the 
new-born baby when they have not been prop- 
erly treated as soon as born by instilling one 
or two drops of one per cent silver nitrate solu- 
tion in each eye. When this inflammation 
develops, pus rapidly forms and calls for stren- 
uous treatment to save the eye-sight. Even in 
older children when an infection of the eyes 
is so severe that pus forms it demands the 
most careful attention and thorough treatment 
to prevent the eye-sight from being badly dam- 
aged or even lost. 

In the treatment of conjunctivitis, even of the 
simple forms, it is a wise plan to shade the 
eyes. In the more severe types, eye patches or 
shades can be worn. These fasten directly 
over the eye, and yet allow the child to open the 
eye without the direct light hitting it. This is 



174 DISEASES OF INFANCY 

important because it allows the secretions to 
drain out and not accumulate beneath the lids. 

In the simpler forms of inflammation usually 
all that is needed is to wash the eye using the 
eye-cup or eye-dropper, filled with boric acid 
solution three or four times a day. If the 
inflammation does not promptly improve a 
twenty per cent solution of argyrol can be used 
three or four times a day. 

In the more severe types of conjunctivitis, such 
as "pink-eye," the boric acid solution will not 
be sufficient and it is best to start the treatment 
in the very beginning with the argyrol or a two 
per cent solution of zinc sulphate. The child 
must be kept away from other children until the 
inflammation has all disappeared. The hand- 
kerchief or gauze used to wipe the secretion 
away from the eye should be put in boiling 
water or burned. 

When pus has formed, either in the new-born 
or in older children, your physician will instruct 
you as to keeping the eye clean by gently irri- 
gating it with the boric acid solution and then 
instilling into the eye a twenty-five per cent 
solution of argyrol at least four times a day. 
The application of cloths wrung out of hot water 
which has been sterilized by boiling will give 
relief where the lids have become greatly 
swollen, hot and painful. 

Trachoma, — This is a contagious inflamma- 



THE EYE AND EAR 175 

tion of the conjunctiva in which little granules 
form on the lining membrane of the eyelid and 
eye. It occurs in children who are crowded 
together in badly ventilated houses or school- 
rooms, especially if the child is run-down and 
anemic. It is quite contagious; children with it 
must immediately be taken out of school, and 
put at once in the hands of an occulist because 
the treatment to be useful must be started early. 
It calls for the use of strong astringent anti- 
septic eye solutions which must be prescribed by 
the occulist, with the more rigid local treatment 
for removing the granules. 

All severe inflammations of the eye may be 
deep-seated and the mother should not experi- 
ment too long before consulting an occulist, 
because what at times appears to be a super- 
ficial inflammation may be the only symptom of 
a deep and severe disease demanding the best 
treatment you can procure from a competent 
eye-specialist. 

Cross-Eyes. — Babies or young children who 
develop the condition of cross-eyes, or of one 
eye turning in or out, must be treated early by 
an eye specialist. The eye which turns in or 
out is not being used and if this condition is 
allowed to continue the power of sight will be 
lost. Correcting glasses must be put on the 
child early to bring the eyes to a straight line, 
or if the condition is too severe, an operation 



176 DISEASES OP INFANCY 

may be necessary to correct the muscles. Never 
allow this condition to continue without proper 
treatment even in the youngest child. 

EYE-STRAIN AND WHY IT SHOULD BE CORRECTED 

We find in children, even before they have 
begun to use their eyes steadily at school, very 
many variations from what we consider the per- 
fect eye. But most commonly we find the 
defects in the lenses of the eyes and we call 
these defects, errors of refraction. This means 
that the eye has to strain more or less, in 
accordance with the seriousness of the error, to 
get a clear picture of an object upon the retina, 

In the perfect eye, the process by which the 
eye focusses to get a clear picture as we turn 
constantly and rapidly from one object to the 
other, is very complicated. Thus we readily 
understand when there are defects in the lenses, 
and added work is put upon the focusing mus- 
cles, eye-strain is a consequence. The defect 
need not be great to cause very severe eye- 
strain. A child with very keen vision, even bet- 
ter than normal, oftentimes suffers more from a 
very slight defect in the lenses of the eye, than 
a child with poor vision will suffer from a much 
greater error. 

We find in general three types of eye-strain 
that we are readily able to correct by glasses 
so ground that they assist the lenses of the eyes 



THE EYE AND EAR 177 

to correct the errors that exist. The fact that 
a very slight error can cause so much strain 
and headache and nervousness, and can be so 
readily corrected, while if left can develop into 
a far more serious error, should lead us to 
attend promptly to any sign of eye-strain no 
matter how early it develops. 

THE FAK-SIGHTED EYE 

The most common error in the lens of the eye 
is what we term far-sightedness. The far- 
sighted eye which is technically called the 
"hyperopic eye-" is shorter than normal from 
front to back and the rays of light which enter 
the pupil tend to come to a focus behind the 
retina instead of at the retina, as they do in 
the perfect eye. This forms an indistinct pic- 
ture. The rays of light from objects at a dis- 
tance tend more nearly to focus at the retina 
in this short eye than the rays from nearby 
objects, so that the eye sees objects at a dis- 
tance more clearly than those near, hence the 
term, far-sighted. If the eye is only slightly 
far-sighted, the ciliary muscle which controls 
the act of focusing may overcome the defect by 
constant activity. The muscle will enlarge, or 
"hypertrophy," as we call it, and up to a cer- 
tain point will be able to give clear vision. But 
this is not a desirable condition for it is never 
safe in any apparatus to have one part stronger 



178 DISEASES OF INFANCY 

in proportion to the other parts. And in this 
case, too, we find serious general symptoms, for 
example, headache and indigestion as a result of 
this unnecessary strain. 

THE NEAK-SIGHTED EYE 

The second form of eye-strain for which it is 
necessary to wear glasses is found in the short- 
sighted or near-sighted eye which occulists call 
the "myopic eye." Objects must be held very 
close to the eye in order to be seen distinctly. In 
this eye, the rays of light, instead of meeting at 
the retina, come to a focus before reaching this 
sensitized plate, and the result is an indistinct pic- 
ture just as in the far-sighted eye. To correct 
this condition it is necessary to place in front 
of the eyes a pair of glasses or lenses which are 
ground so that they will separate the rays of 
light so that they do not unite until they reach 
the retina. The lenses used to do this are con- 
cave, whereas those for the far-sighted eye are 
convex lenses. 

A point which it is necessary to understand 
in the near-sighted eye is this : since the eye-ball 
in such an eye is too long from the front sur- 
face to the back, the delicate membranes within 
the globe or ball of the eye are stretched, and 
from this tension diseased conditions ofttimes 
result. It is possible to have very far-sighted 
eyes and have no diseased condition of the eye 



THE EYE AND EAR 179 

itself, but in the near-sighted eye the stretching 
of the tissues, especially the delicate retina, ulti- 
mately causes injury and in cases of very bad 
stretching blindness may result. 

With the far-sighted eye, excessive activity of 
the ciliary muscle will focus the eye so that a 
certain amount of vision is secured. In the near- 
sighted eye the ciliary muscle must relax com- 
pletely in order to secure vision, and as a result 
of this constant relaxed condition we find very 
weak, under-developed ciliary muscles. 

ASTIGMATISM 

The third condition we wish to study is that 
known as astigmatism. By this we mean that the 
lens does not have an even curve, that the 
curve is greater in one portion of the lens than 
in another. A stigmatic lens is one with per- 
fectly uniform curvature. The lens of the eye 
which is most frequently found astigmatic is the 
cornea or the first lens upon which the rays of 
light fall as they enter the eye. This inequality 
in the curvature of the lens tends to distort the 
picture. You can get an idea of this by standing 
in front of a mirror which has a curved surface 
and noticing the distorted image reflected there. 
While the uneven curvature in the cornea of the 
child's eye may be very slight, its effect must be 
judged first by the fact that it is but one inch 
removed from the retina or " sensitized plate" of 



180 DISEASES OF INFANCY 

the eye, and secondly, by the enormous numbers 
of pictures constantly taken within the eye. 

We now have a clear idea of the three common 
reasons for wearing glasses. We cannot cure 
near or far-sightedness or astigmatism. These 
are mechanical defects in the eye, but with the 
proper glasses we overcome the bad mechanical 
condition and relieve the symptoms caused by it. 

OTHER FAULTS 

Aside from the mechanical defect in the shape 
of the eye or the lens of the eye which causes a 
distorted picture to be thrown on the retina and 
which is a defect that the child is born with, we 
have diseases which cause errors of refraction. 
For example, some of our most severe forms of 
astigmatism are produced by corneal ulcers or 
injuries to the eye which in healing distort the 
surface of the lens, or they may cause diseased 
conditions in the eyes themselves or in any part 
of the body. This brings us to a definite study 
of eye-strain symptoms. 

As a result of the strain we find in the eyes 
themselves, pain, tenderness, redness, irritability 
when exposed to light, redness of the lids, or 
inflamed lids. You wonder why eye-strain pro- 
duces redness of the lids. Nature does all in her 
power to correct our refractive errors for us, 
and one way is by making a pressure with the 
lids upon the eyeballs. This makes it possible 



THE EYE AND EAR 181 

for the child to see better but frequently itching 
and burning of the lids is the result of this pres- 
sure. Then because of this irritation the child 
rubs the lids with the hands or the handkerchief 
and carries infection to the already inflamed tis- 
sue, sties and lid abscesses resulting. 

We frequently notice in the child an effort to 
correct the effects of astigmatism by holding the 
head on one side or elevating the chin. The ex- 
cessive, spasmodic winking and the jerking move- 
ments in the muscles of the face, are frequently 
but an unconscious effort of the patient to smooth 
out the uneven cornea and save the nervous sys- 
tem from the effect of the eye-strain. 

We find inflammation in the eyes themselves 
due to eye-strain. Frequently the ciliary muscle 
is affected, for on this muscle largely lies the 
burden of focussing the eye to compensate for 
the defect in the lenses. 

Of the errors of refraction, astigmatism causes 
the most trouble, not only in local but general 
disturbances, for in this trouble the eye must be 
focused for one meridian where the curvature is 
greatest, and instantly focused for the other 
meridian where the curvature is less, so that the 
work of the muscle and the strain is constant. 

You cannot wonder then that eye-strain can 
cause complications in almost any part of the 
body, especially when you remember that through 
the sympathetic nervous system, as well as the 



182 DISEASES OF INFANCY 

brain, the eye is connected with many of our most 
vital organs. You can understand why headache 
so frequently accompanies eye-strain. Please 
remember that while headache may be caused 
indirectly by eye-strain, it may also come from 
indigestion and constipation or the disturbance 
of any organ of the body, so that this symptom 
must be considered with the others. Mechanical 
errors in the eye can only be detected by a good 
occulist, and as soon as these are known to exist, 
correctly fitted and accurately adjusted glasses, 
constantly worn, are most necessary and valuable 
aids to your child's progress and health. 

EYE-GLASSES 

It is essential that glasses be accurately 
adjusted, kept adjusted and in perfect shape 
mechanically. Do not go to a casual occulist, 
but one in whom you can place reliance year after 
year. Do not purchase cheap frames, as they 
lose their shape and are a constant source of 
annoyance. Buy two pairs of glasses so that if 
one becomes bent or broken another is ready to 
take its place while the defective ones are being 
repaired. 

A mistake frequently made in judging eyes is 
to depend upon the amount of vision. Some of 
the 'most severe cases of eye-strain we find in 
people who have normal, or even better than 
normal vision. People with poor vision very 






THE EYE AND EAR 183 

frequently have less eye-strain than those people 
with very keen vision. 

Another mistake frequently made is to con- 
sider that the need of glasses is dependent upon 
age. The mechanical error of refraction is found 
in the child of five just the same as in the man 
of fifty. The child may have a different group 
of symptoms than the man and the symptoms 
may depend upon the difference in age. The 
reason for this confusion in many minds is easy 
to understand. After the age of forty-five or 
thereabout the power of accommodation begins 
to fail, and we need to use a convex lens to make 
up for this loss. This power of lenses to make 
older people see has been known for hundreds 
of years, but the knowledge which enables us to 
correct the errors of the near and far-sighted 
eyes and astigmatism is of comparatively recent 
development. 

If your child has headache, car-sickness or 
stomach disturbance, astigmatism may be con- 
stantly present, and the correcting lenses should 
be worn constantly if the symptoms are to be 
relieved. 

THE EAR 

Something in the Ear. — Insects and small 
objects get pushed into the ear and in an effort 
to remove them they may be forced against the 
ear-drum where they may set up an Mamma- 



184 DISEASES OP INFANCY 

tion of the drum and middle-ear. To remove 
anything from the ear, syringe it out with warm 
water. Use an ear-syringe or fountain syringe, 
boiling the tip to sterilize it. Let the child lie 
flat on his back with the head turned to one 
side and place a basin beneath the ear to catch 
the water as it flows out. Irrigate the ear by 
letting one or two quarts of boiled warm water 
flow in, in a steady stream. Hold the fountain- 
syringe two feet above the child's head. Grasp 
the upper part of the ear and hold it up and 
back; this straightens the ear canal, and will 
usually wash out anything that has gotten into it 
without injury. 

Earache. — Babies and young children are very 
liable to earache caused by some inflammation 
back of the ear-drum. Babies will roll their 
heads from side to side, be restless and cry out 
as if from colic. Take the temperature first, for 
inflammation of the ear is always accompanied 
by fever. Until your physician arrives to exam- 
ine the ear-drum, drop into the ear three or four 
drops of warm five per cent solution of phenol 
in glycerine. This should be retained, the child 
lying on the opposite side. Bepeat this in six 
hours and it will many times give prompt relief. 
Until you can get the phenol, use warm water at 
a temperature of 110°, in the fountain syringe, 
dissolving two teaspoonfuls of table salt to the 
quart of water. A quart of this normal salt solu- 



THE EYE AND EAR 185 

tion can be used to irrigate the ear every two or 
three hours and will many times stop the ear- 
ache and prevent severe inflammation. If tem- 
perature and earache persist, your physician 
should examine the ear-drum without further 
delay. 

Inflammation of the Middle-Ear. — In measles, 
whooping-cough, influenza, colds, diphtheria, ton- 
sillitis and enlarged tonsils or adenoids, the infec- 
tion frequently extends through the Eustachian 
tube which opens into the back of the throat up 
to the middle-ear and sets up an inflammation 
known as otitis media. In debilitated children 
this inflammation may not be preceded by inflam- 
mation of the nose or throat. 

The opening of the Eustachian tube is close to 
the tonsils and adenoids so that any infection 
or inflammation there is quickly carried to the 
ear. Earache is not always present so that the 
inflammation sometimes exists for quite a period 
before it is discovered, but the child always runs 
some fever and babies will be restless or tug at 
the ear and roll the head. After any of the dis- 
eases mentioned the ear-drum should be examined 
whether there is earache or not. The treatment 
for earache will stop the inflammation unless it 
has progressed to the stage where serum or pus 
forms. 

Bloiving the Nose. — The common method of 
blowing the nose is responsible for forcing infec- 



186 DISEASES OF INFANCY 

tion up the Eustachian tube to the middle-ear. 
In blowing the nose both nostrils should not be 
held closed as this forces the air up into the nasal 
cavity and can readily carry particles back into 
the Eustachian tube. One nostril at a time should 
be compressed, leaving the other open to allow 
free escape of the air, and the nose should never 
be blown vigorously. If children were taught to 
correct this wrong habit early in life much ear 
trouble would be avoided. 

Pus in the Middle-Ear. — When inflammation 
of the ear has run untreated to the stage when 
serum then pus forms and the ear-drum bulges 
outward, the physician must make an opening 
at once in the drum to allow this pus to escape. 
Should it remain in and under high pressure it 
may so injure the delicate bones of the middle- 
ear as to permanently damage the hearing, or it 
may force its way back into the mastoid cells, 
causing the serious condition of acute mastoiditis. 
If the ear-drum ruptures before the inflammation 
has been discovered and if the opening is not 
large enough to allow free drainage, a larger 
one must be made by your physician. As soon as 
the discharge runs from the ear the canal must 
be kept clean by irrigating it every three hours 
with a normal salt solution or a boric acid solu- 
tion, and after each irrigation the canal must 
be gently dried with cotton wound loosely around 
a sterile toothpick. 



THE EYE AND EAR 187 

Procure a soft rubber ear-syringe for this treat- 
ment, or use a fountain syringe. With the young 
child fasten the arms down at the side by pin- 
ning a towel around the body or use a pillow 
slip. The child should lie in the same position as 
for the irrigations already described. A quart 
of the solution should be used, as warm as can 
be comfortably borne, every three hours and this 
treatment continued for ten or twenty days until 
the drum has healed and the discharge entirely 
ceased. 

All this time carefully watch the prominent 
bone back of the ear where the mastoid cells are 
located, and if the skin over it becomes red and 
the bone tender and painful under pressure, 
notify your physician at once because it calls for 
an immediate operation. There are cases where 
this condition of mastoiditis has been cured with- 
out an operation but the danger of taking this 
chance is too great as the mastoid cells are sep- 
arated from the brain by a very thin layer of 
bone. If infection breaks through this, a fatal 
meningitis is set up. 

Chronic Discharge. — At times where there has 
been an inflammation of the middle-ear which has 
ruptured spontaneously, a chronic, oftentimes 
offensive, discharge will persist. The ear should 
be -examined, for it will usually be found that 
the rupture is in the upper part of the ear-drum 
in such a position that the infection has stagnated 



188 DISEASES OF INFANCY 

in the lower part. An opening in the lower part 
of the drum must then be made to allow this 
offensive infection to drain out. The canal will 
then have to be irrigated and kept clean as 
directed. 

Deafness. — Prompt treatment of earache and 
inflammation will prevent impairment of the 
hearing. Children with earache should always 
be examined for enlarged or infected tonsils and 
adenoids and have them removed as the first 
source of the trouble. Enlarged adenoids or ton- 
sils may close the opening of the Eustachian tube 
so that partial deafness results and the child 
appears dull and inattentive. A severe inflam- 
mation of the inner ear where the drum has not 
been opened may cause partial or complete deaf- 
ness in that ear. After some of the acute infec- 
tious diseases, such as scarlet fever, the hearing 
may be lost for a time and in some cases perma- 
nently. Children suffering from a congenital 
blood disease may have temporary or complete 
deafness, which can often be restored by appro- 
priate treatment. In all cases of partial or com- 
plete deafness, a careful examination should be 
made by a reliable ear specialist. 



CHAPTER XIX 

DISEASES OF THE MOUTH, STOMACH AND 

INTESTINES 

THE TEETH AND MOUTH 

Mouth and Fever Sores. — In children whose 
nutrition is below normal and in whom there is 
any neglect or uncleanliness of the month, sores 
which form into little ulcers may appear at the 
corners of the mouth. These are no doubt due 
to a distinct infection because several members 
of a family are seen affected at the same time 
and it also breaks out in schools. It must be 
promptly treated because through the sores other 
infections easily enter. Using sterile gauze 
wrapped firmly about the end of a toothpick 
which has been put in boiling water, gently paint 
over these sores twice a day with a ten per cent 
solution of silver nitrate or the compound tinc- 
ture of benzoin. Over this should be put a little 
zinc oxide ointment several times each dav to 
protect the painted sores. With this treatment 
the sores will heal in a very few days. 

Fever sores, medically called herpes, appear 
on the lips and may extend out over the cheeks. 
They come after fever, after pneumonia, expos- 

189 



190 . DISEASES OF INFANCY 

ure to winds, colds, grippe, with attacks of indi- 
gestion and in some children no cause can be 
traced. They appear first as little blisters, 
crowded together, last about a week and dry up, 
forming scabs. The eruption can sometimes be 
prevented by painting over the little reddened 
burning areas with collodion or touching them 
frequently with camphor water or alcohol. When 
they do break out, cover with collodion to keep 
from the air. This relieves the pain and hastens 
the drying up. Frequent touching with alcohol 
or camphor acts in the same way. 

The Teeth. — The coming of the first or "milk" 
teeth is subject to very wide variation. They 
normally appear about the sixth month, but may 
occur as early as the third or as late as the 
twelfth. Occasionally a baby is born with a 
tooth which is poor, loosely attached and is 
drawn. Delayed dentition is a strong indication 
of some error in nutrition, frequently of rickets. 
Teething is a normal process and should cause 
little disturbance. Many of the symptoms attrib- 
uted to teething are due to indigestion and other 
troubles which should be looked into and not 
simply passed by as "teething." Should* the 
gums become swollen, and painful with little 
sores, the child fretful with fever, vomiting and 
having a little diarrhea wash the mouth with a 
cool solution of boric acid. Wrap sterile cotton 
around the finger a-nd gently swab out the mouth 




The Organs of Digestion Showing Their Relative Size and 

Position. 1 — Esophagus. 2 — Stomach. 3 — Pylorus. 4 — 

Small Intestine. 5 — Bile Duct. 6 — Pancreatic Duct. 

7 — Ascending Colon with Appendix Shown at 

the End. 8 — Transverse Colon. 9 — 

Descending Colon. 10 — Rectum. 



192 DISEASES OF INFANCY 

once or twice a day. (This treatment should not 
be continued longer than a week unless absolutely 
necessary for if enough boric acid is swallowed 
it upsets digestion.) A little piece of clean ice 
in a clean cloth can be held over the inflamed 
gum. If the child is kept awake at night by the 
pain, four or five drops of paregoric can be 
rubbed over the gum where the teeth are coming 
through. The gums should never be lanced 
except as a last resort. . 

Gum-boil. — When teeth are neglected an 
abscess may develop at the root of a tooth caus- 
ing fever and swelling and this develops a gum- 
boil. This ruptures and discharges pus into the 
mouth. When the gum-boil becomes soft it can 
be opened before rupturing, shortening the attack. 
Because the pus is poisonous the mouth should 
be carefully washed out several times a day with 
boric acid solution. 

Decayed Teeth. — From the very beginning the 
baby's teeth must be kept clean. This is the most 
important measure to prevent decay. Food 
allowed to collect around and between the teeth, 
especially sweets, quickly ferments, destroys the 
enamel and starts decay. Infection from decayed 
teeth quickly attacks their roots and the gums 
around the teeth, setting up inflammations. 
Toothache, imperfect mastication, foul breath, 
and abscess at the roots follow. The infection 
from the abscess at the roots readily infects 



MOUTH, STOMACH AND INTESTINES 193 

the glands below the jaw and gradually this 
extends to other parts of the body. 

In many children anemia, steady fever and 
rheumatism in its various forms are the direct 
result of decayed and neglected teeth. In other 
children headache, nervousness and twitchings 
of the muscles of the face and other muscles over 
which the child has no control are due solely to 
decayed teeth. The use of the tooth-brush, dental 
floss to clean between the teeth and the mouth 
wash of salt-water, (one teaspoonful to the glass) 
used to rinse out the particles of food, should 
early be taught the child. Oandy should be 
eaten only with meals as part of the dessert, and 
the teeth and mouth cleaned and rinsed after 
each meal. 

At the first sign of decay of the teeth or inflam- 
mation of the gums the teeth should be properly 
treated and filled. They should be extracted only 
when abscesses at the roots make it necessary as 
the loss of a single tooth impairs mastication 
and the digestion of food. Watch carefully the 
teeth which come about the sixth year known as 
the six-year molars. Have them taken care of 
so that they do not have to be pulled as these 
are important permanent teeth but often mis- 
taken for first teeth. 

Inflammations and Ulcers in the Mouth. — The 
mucous membrane lining the mouth can become 
red, swollen and painful, especially at the time 



194 DISEASES OF INFANCY 

of teething, and this can occur in all young chil- 
dren from indigestion, from any of the infectious 
fevers, from dirty bottles, nipples or unclean 
milk, and from any harsh treatment, such as 
rough cleansing of the mouth or rubbing of the 
gums. In more severe forms, small ulcers form 
and may extend all over the lining. ■ This is 
known as thrush. Prevention is in using the 
greatest care in cleansing the mouth thoroughly 
but most gently and seeing that all bottles and 
nipples, or the nipple of the mother, are strictly 
clean. When the mouth is so sore that nursing 
is painful, the baby should be fed from a spoon. 

If simple inflammation occurs without ulcers 
the mouth should be washed with cold water after 
each feeding. This should be done most gently 
with cotton wrapped about the little finger. Have 
your druggist make a 1 :10,000 solution of potas- 
sium permanganate and use this cold in wash- 
ing the mouth. Or, use a cold saturated solution 
of boric acid in the same way. Medicine given 
internally is unnecessary. 

Where tiny ulcers have formed use the potas- 
sium permanganate stronger, 1 :5000. If the child 
is old enough the milk should be taken cool. In 
older children all foods should be liquid or semi- 
liquid and given cool until the ulcers have healed. 
All acid fruit juices should be avoided while the 
mouth is sore, using prune or peach juice in 
place of orange juice until the sores have healed. 






MOUTH, STOMACH AND INTESTINES 195 

In older children who have been run-down or 
careless in the cleaning of mouth and teeth, 
deeper ulcers may form which require the atten- 
tion of your physician, as unless properly checked 
and treated they may cause the decay of pieces 
of membrane in the mouth. The mouth must be 
washed with a solution of potassium permanga- 
nate as strong as 1:1000. The teeth must be 
kept strictly clean, nothing but liquid or soft 
foods should be given and your physician will 
prescribe small doses of chlorate of potash to be 
taken internally. The dose will be two grains 
every three hours for a child of four or over. 

INDIGESTION 

Acute Indigestion, — In babies, whether breast- 
fed or bottle-fed, a sudden attack of indigestion 
is brought on by too much milk, by milk too rich 
in one of its elements such as too much cream 
or fat, or by too much sugar in the milk or the 
milk-mixture, or from contaminated milk. The 
giving of foods to which the child is unaccus- 
tomed, or over-feeding and the eating of such 
distinctly indigestible foods as hot breads, fried 
meats, rich cake, pastry, too much candy espe- 
cially rich chocolates, unripe or over-ripe or very 
acid fruits, all readily produce acute indigestion 
in young as well as older children. Very cold 
foods or drinks, such as ice cream eaten too 
quickly or in too large amounts or iced drinks 



196 DISEASES OF INFANCY 

cause acute indigestion in the child with delicate 
stomach or in any other child who has over-eaten 
or become over-heated. Acute indigestion will 
follow fatigue, excitement and over-exertion, such 
troubles being especially prevalent during hot 
weather. 

The undigested food lies too long in the stom- 
ach, ferments and gas forms and fills the stomach. 
Older children complain of stomach-ache; in 
babies the region about the mouth or the entire 
face becomes pale and perspiration breaks out 
on the forehead. Vomiting relieves the child 
for a little time. In babies this is sour and in 
large, curdy masses. In older children it is 
not only sour but filled with undigested pieces of 
food even though it may occur five or six hours 
after eating. One act of vomiting may entirely 
empty the stomach of this mass of undigested 
food arid the gas be entirely belched up. More 
often repeated vomiting occurs, bringing up only 
a little food at a time. The child may be quite 
acutely ill with fever, coated tongue, foul breath, 
prostration, and a great deal of pain in the 
stomach. There may be headache and constipa- 
tion, and diarrhea may come on. The urine may 
be scanty and highly-colored. The child may be 
very restless, irritable, thirsty and sleepless. 
Where the attack is very severe and the child 
delicate, convulsions may start the attack or 
come on later. Between the attacks of vomiting 



MOUTH, STOMACH AND INTESTINES 197 

some children ask for food, others show an entire 
loss of appetite. 

Treatment. — The object is to get the undi- 
gested food out of the stomach as soon as pos- 
sible. If the vomiting is severe, get the child to 
drink as much warm water as possible. This 
will be vomited up and helps wash out the stom- 
ach. If the vomiting is not severe, give a big 
dose of castor oil to move the bowels quickly. 
If you can't get the child to take castor oil give 
a big dose of milk of magnesia. Clean the lower 
bowel out at once by giving a soap-suds enema as 
hot as the child can stand it. To relieve the stom- 
achache put a hot-water bag or cloths wrung out 
of hot water over the stomach. In tfye water put 
one-half teaspoonful of turpentine to the quart. 
Give sips of hot peppermint water. Stop all 
food but have the child take frequent small 
drinks of water! After the vomiting has ceased 
put a teaspoonful of lime water in each glass of 
water; this helps quiet the stomach. After 
twenty-four to thirty-six hours, and after all 
vomiting and fever have disappeared, give the 
baby barley water or albumin water in place 
of his usual feedings. After a few hours begin 
adding to the barley water half the usual feeding 
in skimmed milk. Eeturn very cautiously and 
slowly to the regular feeding. For older children 
the first food should be thin gruels, a little 
chicken or mutton broth with all the fat skimmed 



198 



DISEASES OF INFANCY 



off. If this food is taken all right add skimmed 
milk diluted with water or Vichy water. Unless 
yon are very cautions about getting the child 
back to the regular diet the attacks of indiges- 
tion are liable to recur. 

Intestinal Indigestion. — The symptoms and 
causes which we have just described in acute 
indigestion are the same here. The food that 
is causing the trouble has gotten past the stom- 
ach into the intestines, there setting up fermen- 
tation and decay and formation of gas, giving 
great distress and pain in the bowels, and quickly 
developing diarrhea. It must be treated in 
exactly the same way. This type of indigestion 
merges into, and is closely associated with sum- 
mer diarrhea and food poisoning and is taken 
up in Chapter XX. In babies this condition is 
due to neglected constipation or diarrhea caused 
by habitually giving unsuitable food, food too 
strong in some one or more of its elements such 
as milk too rich in cream or fat, or a too high 
sugar feeding, or feeding at too short intervals. 
In bottle-babies this error in feeding is oft- 
times due to the fact that the mother does not 
understand the nature of the prepared food she 
is using. For example, she may be adding milk- 
sugar to a preparation already rich in sugar, 
or she may be using the cream from the top of 
the bottle of milk, instead of shaking up the 
bottle and using so many ounces from the whole 



MOUTH, STOMACH AND INTESTINES 199 

milk, as called for in her feeding formulas. 
Again it is due to allowing the baby to nurse 
too long at the breast, or to failure to analyze 
the mother's milk at the first signs of disturbance 
in the baby's digestion to see if the milk is 
too rich in some element. In the older baby 
this chronic indigestion follows the habitual giv- 
ing of table foods unsuited to his digestion. The 
bowel movements during intestinal indigestion 
will always show quantities of undigested food 
and curds. 

In older children chronic intestinal indiges^ 
tion is often due to the habitual giving of some 
one article of food that does not agree with the 
child. The poisons thrown off from this improp- 
erly digested food enter the system. The child 
may have attacks which come on at regular or 
irregular intervals. During these attacks there 
is sudden rise of fever, vomiting, a good deal of 
distension of the abdomen with gas, diarrhea, or 
at times constipation. Between the attacks the 
child is apparently well. In other cases the child 
seems to be ailing all the time from no apparent 
definite cause. These children will usually be 
anemic, have coated tongue with bad breath, con- 
siderable colic and gas and are as a rule con- 
stipated, although they may have spells of diar- 
rhea. They are always restless at night, often 
grinding the teeth and talking in their sleep. 
While they may appear bright in the morning 



200 DISEASES OP INFANCY 

they tire easily and begin to look tired, often with 
circles under the eyes, toward night. 

Usually the mother believes the child has 
worms because of the restless nights and the bad 
breath. A little experimenting will always dis- 
close some error in the diet. Milk is one of the 
common disturbants in children during and after 
the run-about age. They may not take cream 
well and are often given too much milk. In 
some the cream upsets the digestion; in others 
the entire milk is badly digested and must be 
omitted. Other children do Hot digest eggs 
well; some cannot take them at all without trou- 
ble; others should have only one a day; still 
others only one or two a week. Again we find 
children with a great meat appetite and they are 
allowed too much. Meat three or four times a 
week is sufficient for the child under five, and 
some cannot digest it properly that often. Chil- 
dren between five and ten should not have meat 
oftener than once a day. Mothers make the error 
at times of not considering poultry and fish as 
meat and will give a child meat for dinner and 
chicken or fish for supper. This is wrong. 

When an attack of fever and vomiting begins, 
clean out the bowels well with good sized doses 
of rhubarb and soda or milk of magnesia. Pay 
strict attention to the bowels after the attack 
and do not allow constipation to exist. If the 
child has not had a bowel movement during the 






MOUTH, STOMACH AND INTESTINES 201 

day he must be given an enema at bed-time 
before he is allowed to sleep. Encourage the 
eating of well-cooked green vegetables and all 
properly ripened seasonable fruits. The child 
with indigestion should be especially encouraged; 
even to* the extent of bribing or making it a game 
or a contest ; to drink five or six glasses of water 
each day. These children should have outdoor 
exercise, plenty of fresh air day and night, with 
a rest of one or two hours at midday. 

Bilious Indigestion. — When bile, which is 
secreted by the liver, is mixed in proper amounts 
with the contents of the intestines the movements 
are of a brownish color. They become clay- 
colored or almost white when there is a lack 
of bile and digestion is incomplete. Nausea, 
vomiting, faintness, dizziness, sallow skin, head- 
ache, gas, bitter taste in the mouth and constipa- 
tion are the symptoms. The treatment is the 
same as for intestinal indigestion except that 
before the rhubarb and soda or milk of magnesia 
it is a good plan to give one-tenth grain doses of 
calomel every half hour for five doses and let 
the purgative follow half an hour after the last 
dose of calomel. 

JAUNDICE 

When this appears in new-born babies and per- 
sists after the fifth day, a few drops of castor 
oil given internally will clear the skin. It 



202 DISEASES OF INFANCY 

usually disappears of itself in five to ten days. 

In older children there is a form known as 
catarrhal jaundice caused by an inflammation 
in the upper part of the intestine around the 
opening of the gall duct which shuts the duct off 
and prevents the bile from entering the intes- 
tine freely. The bile backs up, gets into the blood 
and the skin becomes yellow. This inflammation 
is caused by an infection and may occur in sev- 
eral members of one family. It is not due to 
improper diet. 

The first signs of catarrhal jaundice may be 
the yellowish cast of the membrane lining the 
eye-ball, the white of the eye becoming distinctly 
yellow. There is usually a little fever, a coated 
tongue, a great deal of headache, nausea and 
vomiting. The child is listless and sleepy, the 
skin soon turns yellow and the urine will be 
very dark colored, containing quantities of bile, 
and the stools will be light-colored or grayish. 

The treatment is to stop all food and give a 
good sized dose of sodium phosphate or rhu- 
barb and soda. Do not give calomel. Repeat 
either one of these cathartics each day to pro- 
cure good bowel movements. Water containing a 
pinch of bicarbonate of soda must be given freely. 
On the second or third days, as soon as the vomit- 
ing has stopped and the fever is gone, give bar- 
ley water, strained thin gruels, chicken broth 
with a little* toast or zweibach, orange juice and 






MOUTH, STOMACH AND INTESTINES 203 

stewed fruits. Do not allow milk or eggs for 
several days until , all the jaundice has dis- 
appeared. As soon as food is given five drops 
of dilute nitro-hydrochloric acid in a quarter 
glass of water should be taken after each meal, 
by children after the fifth year. 

DYSENTEBY 

This disease is frequently spoken of as ileo- 
colitus or colitis and is due to infection which 
has gotten into the intestine and affects the large 
bowel. The attack begins with fever, sometimes 
vomiting, thirst and a serious diarrhea with num- 
erous stools, the passage accompanied by pain 
and griping. The fecal matter is soon expelled 
and the stools are made up of mucous streaked 
with blood or with quantities of blood. The 
griping pains in the abdomen are very severe 
and as the diarrhea persists thirst is aggra- 
vated by the fever and great loss of fluid. The 
loss of flesh is rapid. The disease runs a course 
of several days, sometimes two or three weeks, 
and unless checked tends to become chronic. 
Should no improvement take place, death may 
occur in one or two or three weeks from the 
constant loss of blood and the great exhaustion 
due to the continual discharges from the bowels 
which are more and more offensive and which 
the patient is not able to control. As the dis- 
ease progresses, there is danger of ulcers form- 



204 DISEASES OP INFANCY 

ing in the bowel which heal very slowly and in 
severe cases may eat through the bowel, causing 
a fatal peritonitis. 

The treatment should be started by giving a 
half tablespoonful of castor oil for younger chil- 
dren and a tablespoonful for older ones. If the 
child does not retain this, give one-tenth grain 
of calomel every half hour for six doses and 
follow this by a cathartic dose of sodium phos- 
phate dissolved in hot water. The castor oil or 
the calomel with the sodium phosphate should 
be repeated every second or third day until the 
diarrhea ceases. A few drops of paragoric put 
in the castor oil will relieve the griping pains 
in the abdomen. Cloths, wrung out of very hot 
water, should be placed over the abdomen, and 
frequently changed. All solid food must be 
stopped in older children and in babies the milk 
must be stopped, giving instead cereal water 
made from barley, oatmeal or rice flour or 
Imperial Granum. Use one rounded tablespoon- 
ful to each pint of water, boil thirty minutes, 
adding water for that which boils away. For 
children over one year use two tablespoonfuls of 
the flour and prepare in the same way and add 
an ounce of chicken broth to each feeding and 
salt to taste. If you reside in a city near a hos- 
pital get protein-milk for two feedings during 
the day. (Instructions for preparing this are 
to be found in the volume, The Proper Feeding 



MOUTH, STOMACH AND INTESTINES 205 

of Infants.) Give babies one-half the amount of 
the regular feeding. Children after the first year 
can take six ounces of protein-milk diluted with 
six ounces of water twice a day. If the diarrhea 
has stopped you can add one-half ounce of 
skimmed milk to one of the cereal water feedings 
daily. If this does not set up a diarrhea, the 
following day add it to two feedings. As the 
baby improves, skimmed milk can be added to 
every feeding. This must also be done with older 
children, gradually increasing the skimmed milk. 
After two or three weeks without a return of 
diarrhea you can go back to the whole milk feed- 
ing. For children after the first year add a 
little chicken or mutton broth to each feeding. 
Fruit juices, preferably orange juice, can then 
be given to babies and older children. After 
getting the older children back gradually to the 
whole milk diet add other foods cautiously. 
After the diarrhea is stopped, buttermilk is a 
splendid substitute for the skimmed milk. 

MUCOUS COLITIS 

This condition is an inflammation of the colon 
or large bowel which comes on very gradually, 
producing a catarrhal condition with large quan- 
tities of mucous. This mucous forms a false 
membrane or coating over the lining of the large 
bowel and is cast off in the stools in stringy, 
tough, worm-like masses; at times in large pieces 



206 DISEASES OF INFANCY 

like a rubber tube. When this condition is found 
it is always discovered that the child has habitual 
constipation, belongs to the nervous type and 
generally lives in an environment where there 
is considerable contention, commotion or nervous 
tension. These children are undernourished, as 
a result of these conditions often coupled with 
bad hygiene and improper diet. In many cases 
they have been allowed to indulge an appetite 
for one or two articles of food at the expense 
of a well-balanced diet. They may have had 
quantities of milk and little of the other essen- 
tial foods. A characteristic symptom is slight 
pain in the stomach, never severe enough to send 
the child to bed. The mucdus may appear every 
day in the stools, or it may be absent for a time 
and then appear again for a few days in large 
amounts. 

Treatment. — The constipation must first be 
overcome by using oils which sooth the lining of 
the bowels. Just before bed-time inject sweet 
oil or olive oil into the bowel. Olive oil is pre- 
ferable because part of it is absorbed and the 
child needs this extra nourishment. Get a small 
rectal tube which you can pass five or six inches 
up into the bowel; set into the end of the tube 
a small funnel and pour in two or three ounces 
of the oil. This will be retained all night by most 
children. (These children should receive a tea- 
spoonful of olive oil with each meal.) Also 



MOUTH, STOMACH AND INTESTINES 207 

obtain one of the mineral oils such as Nu-jol or 
Interol and give one-half tablespoonful to 
younger children, one tablespoonful for older 
children (more if necessary) each night at bed- 
time. This oil is given by the mouth. It soothes 
the lining of the bowel and softens the movement 
so that it does not irritate the inflamed bowel 
wall. None of this oil is absorbed. This treat- 
ment of using the oil should be continued for a 
number of weeks after all signs of mucous have 
disappeared. 

Diet. — Discontinue milk for a time. Give 
thoroughly cooked cereals, with plenty of butter 
and some sugar (not milk or cream) ; whole- 
wheat bread spread thickly with butter, cooked 
fruits which are very valuable ; orange and prune 
juice ; chicken broth ; lamb broth ; minced chicken ; 
small portions of finely chopped, well cooked 
lamb; strained vegetable soup; puree of peas (no 
other plain vegetable soups or purees) and 
strained well-cooked vegetables in small amounts. 
In addition use poached or soft-boiled eggs (if they 
are taken well) and junket, Jell-o or any plain 
dessert that is made with little or no milk. But- 
ter should be served freely to the child in this 
condition. The good butter substitutes may be 
used if butter cannot be had freely. Four or 
five glasses of water should be taken between 
meals during the day and the child should have 
an abundance of rest, sleep and fresh air, and 



208 DISEASES OF INFANCY 

be surrounded by quieting rather than disturbing 
influences. 

The Baby. — Before the first year mucous 
sometimes occurs in the stools due to an error 
in feeding. This calls for the mineral oil by the 
mouth, not by rectum, and for the right formula 
of modified milk or an examination of the breast- 
milk to see if it is too rich or too poor. Feeding 
formulas are contained in the volume, The Proper 
Feeding of Infants. 

OBSTRUCTION OF THE BOWELS 

This is a most serious condition. The child 
becomes suddenly sick with alarming vomiting 
and everything put in the stomach comes up. A 
part of the intestine has doubled in upon another 
part so that nothing can pass. The child continues 
to vomit until the stomach is entirely emptied, 
then begins vomiting bile and foul smelling mat- 
ter from the upper intestine. The vomiting 
steadily gets worse; everything given to check it 
comes up. There is only a little fever at the 
start but this increases. There may be one 
movement which is the passing out of the fecal 
matter below the obstruction. The child con- 
tinues to pass from the bowel mucous and bile 
with some blood. The stomach is terribly dis- 
tended with gas ; the child desperately ill, utterly 
prostrated, with pale face and drawn lips. This 
comes on suddenly and becomes critical in a few 



MOUTH, STOMACH AND INTESTINES 209 

hours. It is often mistaken for summer diarrhea, 
but in the latter condition there are always 
many watery stools, while with an obstruction 
we have only the passing of the matter that was 
left in the lower bowel at the time of the obstruc- 
tion and when an enema is given only mucous 
and bile are passed, no fecal matter. 

There is only one thing to do; send for the 
physician instantly. The condition calls for 
immediate operation and the longer the delay 
the less the chance of saving the child's life.' 

APPENDICITIS 

Acute Appendicitis. — This is not uncommon in 
children although it is rare in infancy. It is 
difficult to detect because pain is not always 
present and when it is, the child is vague in his 
location of it. When typical pain is present it 
is centered about a spot just below the middle 
of the line you would draw from the umbilicus 
to the right hip-bone. An attack of acute appen- 
dicitis will bring on vomiting, colic and some- 
times diarrhea with a variable amount of fever. 
All these symptoms are present in ordinary indi- 
gestion, but in appendicitis the child will be 
found to be rigidly holding the muscles on the 
right side of the abdomen when gentle pressure 
is made over them. When there is no question 
in your physician's mind of the presence of 
appendicitis it is most unwise to resist an opera- 



210 DISEASES OP INFANCY 

tion because while some cases will get well 
without an operation some will not, and if you 
operate in time all will get well. 

Chronic Appendicitis.— There are children 
who have a continual mild inflammation of the 
appendix. Their symptoms are generally those 
of chronic intestinal indigestion and in some 
cases only amount to a constant uncomfortable 
feeling in the abdomen. If the child is asked 
to point out the painful spot he will usually put 
his hand over the umbilicus. Some children with 
this condition will have every few months a 
sudden flare-up of colic and diarrhea, vomiting 
and fever lasting three or four days and sub- 
siding. After following out the treatment sug- 
gested in this chapter for chronic intestinal indi- 
gestion and carefully regulating the hygiene and 
diet, if you find the symptoms still present you 
can be reasonably suspicious that the condition 
is due to chronic appendicitis. 

Your physician should then make a careful 
study of the case and if he is convinced that 
the appendix is chronically inflammed he will 
advise its removal to forestall a sudden and dan- 
gerous acute attack of appendicitis. 

PROLAPSE OF THE RECTUM 

As a result of long continued constipation or 
diarrhea, especially in frail or debilitated chil- 
dren a portion of the rectum will protrude from 



MOUTH, STOMACH AND INTESTINES 211 

the anus; sometimes extending outward for sev- 
eral inches. The first thing to do is to stop 
the diarrhea and not allow constipation. Keep 
the bowel movement soft by giving a dose of 
mineral oil each night at bedtime. At the time 
of the bowel movement, with a piece of gauze 
or linen wrapped about the finger, the mother 
should gently push up on the perineum just in 
front of the rectum. The movement should be 
had with the child lying on a bed-pan. If a 
great deal of bowel protrudes and does not go 
back, wring cloths out of very warm water and 
apply to the protruding part. While doing this 
have the child lying on his back with his hips 
elevated on a pillow. 

FISSURES 

Gracks sometimes occur around the anus in 
young babies as a result of hard constipated 
bowel movements or harshness in giving enemas. 
These are extremely painful and often so deep 
that they will bleed. They cause constipation 
because the child will fight off having a bowel 
movement through fear of the pain. This must 
be treated by softening the bowel movements 
by giving mineral oil each night at bedtime. 
Wash the anus carefully after each movement 
and gently apply with the finger boric acid oint- 
ment (thirty grains of boric acid to the ounce of 
vaseline) to the fissures. In stubborn cases use 



212 DISEASES OF INFANCY 

twenty per cent ichthyol put up in zinc oxide 
ointment. Apply after each bowel movement. 

INTESTINAL WOKMS 

Pin-Worms. — This variety of intestinal worm 
causes nervousness, grinding the teeth, restless 
sleep, itching of the rectum, picking the nose, 
and in severe cases, convulsions. In girls they 
sometimes crawl forward irritating the vagina 
and producing leucorrhea. Grive a large dose of 
castor oil at bedtime and watch the stools next 
morning. Pin-worms look like small pieces of 
white or yellowish thread. They are difficult 
to get rid of at times and the treatment must 
be persisted in. When discovered give an enema 
at bedtime, washing out the bowel; then lay the 
child on the side and pour into the bowel by 
means of the syringe with a No. 18 American 
catheter attached, and inserted five or six inches 
in the rectum, six ounces of the infusion of 
quassia. Have the child retain this, if possible, 
all night. Each morning before breakfast give 
the child a dose of rhubarb and soda or com- 
pound licorice powder in warm water. Repeat 
until all signs have disappeared. 

Round-Worms. — These are larger, longer and 
redder than the pin-worm, and are like a small 
earth-worm. Give a dose of castor oil and if the 
worms are found in the stools repeat this dose 
the next night. The next morning, an hour and 



MOUTH, STOMACH AND INTESTINES 213 

a half before giving any food, give X A or y 2 
grain of Santonin (depending on the age of 
the child), which your druggist will put up in 
a little powder, the taste disguised by sugar of 
milk. Omit the oil that night and repeat the 
Santonin next morning. Give the Santonin for 
three mornings, omitting the oil at night, then 
omit the Santonin for three days, giving the oil 
at night and repeat the Santonin again for two 
days. This usually eradicates the worms entirely. 
Another treatment for round-worms is three or 
four drops of oil of chenopodium on a lump of 
sugar given twice a day for three days to a 
child over five years, followed by a dose of castor 
oil on the third night. 

Tape-Worms. — These are rare in children. 
The common symptoms are restlessness, colic, 
foul breath and an abnormal appetite with a 
thin, poorly nourished body. The treatment is a 
big dose of castor oil at night and the next 
morning, two hours before breakfast, a half- 
teaspoonful of oleoresin of male-fern, which your 
druggist will prepare in emulsion. The male- 
fern must be fresh. Keep the child on a very 
light diet of broth or gruel. When the worm is 
passed, carefully examine it for the head. If 
the head is not present the treatment must be 
repeated in three or four days. Until the head 
is removed the worm keeps growing. 



CHAPTEE XX 
FOOD POISONING 

CHOLEKA INFANTUM OE "SUMMER COMPLAINT' ' AND 
PTOMAINE POISONING 

Food poisoning is the result of taking into tlie 
system poisonous bacteria by eating contam- 
inated food or drinking contaminated milk. It 
is more prevalent in the summer months because 
heat favors the growth of bacteria. 

The most commonly contaminated foods are 
milk, and meat that has been kept several days, 
especially when minced and prepared in the 
form of sausage and allowed to stand in a 
warm place. Cooked meat, left over, and served 
after several days or even hours of exposure is 
often unfit to eat. Chicken, minced or pressed 
and left standing, is especially subject to con- 
tamination. Bacteria may start in food that 
is left for a time exposed in a warm room and 
then put on ice, laying dormant until the food 
is taken out. This is true of fish which under- 
goes contamination much more rapidly than 
meat. Ice cream made from contaminated milk 
has caused severe poisoning in children. The 
poisonous variety of mushroom is responsible 

214 



FOOD POISONING 215 

for ptomaine poisoning many times and the 
edible variety can also become contaminated 
through contact with spoiled foods. 

Cooking kills bacteria and if the bacteria have 
set up chemical changes in the food, cooking 
renders these changes less dangerous. If you 
have left-over food or food that has been 
exposed, cook it before serving, even though it 
has stood on ice. In warm weather these foods 
that are the cause of so much poisoning should 
not be bought in larger quantities than can be 
used witMn a few hours. 

THE SYMPTOMS 

In the baby who has been poisoned by con- 
taminated milk and in the older child who has 
eaten spoiled food, the symptoms are similar: 
vomiting, fever and diarrhea. Vomiting is not 
always present but- when it is, is usually severe, 
and as it continues yellow bile appears. There 
is always fever; the temperature usually shoots 
up abruptly and is prone to become extremely 
high in both infants and children; 102°, 103° and 
105° are not unusual in cases of food poisoning. 
It will also be found that the child breathes very 
rapidly. 

Diarrhea is always present and the stools 
very foul, shortly becoming watery, brownish in 
color or very green. There may be two or three, 
or fifteen or twenty movements in twenty-four 



216 DISEASES OF INFANCY 

hours. These contain particles of undigested 
food and in babies, curds. 

The vomiting and diarrhea rapidly extract 
water from the system and the child quickly 
shows loss of weight, the face becoming pale and 
pinched, the eyes sunken. If the child is old 
enough, pain in the abdomen, which is tense with 
gas, will be complained of, often before the vomit- 
ing and diarrhea start. 

The poisons absorbed into the blood from the 
bowels attack the nervous system and restless- 
ness and irritability are among the first signs of 
food poisoning. The child will roll from side 
to side and throw his arms and legs about. As 
the system becomes swamped with poison, the 
child grows dull and listless, or becomes uncon- 
scious, preceded many times by convulsions. 

When the poisoning is of a mild character the 
symptoms will be mild; the vomiting and diar- 
rhea will be slight; the nervous symptoms 
scarcely noticeable. When a great deal of poison- 
ing is introduced into the system from badly 
contaminated milk or other food all these symp- 
toms become severe, and unless promptly treated 
can result fatally within a few hours. 

THE TKEATMENT 

The treatment must be prompt and it must be 
complete in every detail. If a child starts with 
fever, diarrhea and pain in the abdomen, give 



FOOD POISONING 217 

a good cathartic, preferably castor oil. The 
cathartic has got to be sufficient to sweep every- 
thing out of the bowels. Some children will not 
take castor oil; then give a big dose of milk of 
magnesia or citrate of magnesia. Give a child 
five years old four teaspoonfuls of the milk of 
magnesia or three ounces of the citrate. This 
is the magnesium citrate in solution which you 
buy at your drug store. Don't wait to give 
calomel, which has to be strung out over five or 
six doses. What you want is action at once, not 
in five hours. Sometimes you have a child who 
is vomiting and cannot take this dose without 
throwing it up. 

If you live where you can get a doctor quickly 
to wash out the stomach this is the best thing 
to do. If not, put a half teaspoonful of baking- 
soda in a glass of warm water and make your 
child drink one, two or three glasses, if possible. 
He will vomit it right up and that is exactly what 
you want to accomplish. This washes out the 
stomach, and stops the vomiting. As soon 
as the vomiting has stopped, or shows signs of 
abating, begin putting milk of magnesia into the 
water you give the child, using three or four tea- 
spoonfuls. Some of this may come up. Repeat 
the dose again in a few minutes. While you are 
doing this fill your fountain syringe with a quart 
of very warm water, put three teaspoonfuls of 
bi-carbonate of soda in the water, and begin 



218 DISEASES OF INFANCY 

flushing out the bowels, running in as much water 
as the child can hold and then have him pass it 
out. Repeat this enema two or three times until 
you have been able to get a cathartic retained on 
the stomach which will empty the bowels. 

As soon as a good cathartic has been retained, 
get your child in bed. Wring out flannel cloths 
from water as hot as the child can bear. Put 
ten drops of turpentine in a quart of this water 
and cover the entire abdomen with the flannel. 
Lay a towel over the flannel to keep in the heat. 
Change the flannels as fast as they cool. If the 
child has retained the cathartic long enough for 
it to have passed into the bowel, which means for 
twenty-five or thirty minutes, and he is very 
thirsty, let him have frequent sips of water, — 
not big drinks now, because you have the stomach 
washed out, and you don't want the child to 
vomit because you desire the cathartic to be 
retained to clean out the bowels. 

If the child's body is very hot and feverish, 
sponge him off with a little cool water. Put a 
teaspoonful of common table salt in each pint 
of water you use, or use one-third alcohol and 
two-thirds water to sponge off the body. 

The whole problem is to get the bowels to move 
thoroughly. After they are thoroughly emptied, 
the movements will be watery but the foul odor 
will have disappeared. If the diarrhea and foul 
odor keep up you will have to give another 



FOOD POISONING 219 

cathartic. Always remember, if the child can 
keep it down, castor oil is going to give you 
the best result. The second cathartic will be 
probably all that is necessary to completely 
clean out the bowels. When this is accomplished, 
the child must rest in bed. This means that 
you are not to give a bit of food by the mouth, 
nothing but water or barley water for either 
infant or grown child. And this must be kept 
up for thirty-six hours or longer until the diar- 
rhea is checked and the vomiting and fever have 
disappeared. 

With a baby you can then gradually begin 
feeding skimmed milk, which has been boiled, 
reducing the amount of the feeding to one-half 
the usual amount, and diluting the skimmed 
milk with barley water. As the baby improves 
from day to day you can gradually return to 
your regular feeding. 

In older children, begin with milk. This does 
not need to be skimmed milk, but boil it for three 
minutes. Dilute it with one-third water or Vichy 
water. The next day, if there are no signs of 
the return of the diarrhea, add gruels and milk 
toast. The following day, if there is no sign of 
diarrhea, add a soft-boiled egg y a little junket or 
custard, and from this on you can gradually 
put the child back on the regular diet. Remem- 
ber to go back to the usual foods slowly and never 
start foods until the bowels have been completely 



220 DISEASES OF INFANCY 

cleaned out and the temperature and vomiting 
have disappeared entirely because you can easily 
bring back an attack by starting the food too soon 
or by over-feeding. 

Whenever a child develops symptoms of food 
poisoning, such as we have just discussed, it is 
always important to remember that the system 
rapidly gets into an acid state. One of the 
important measures is to give as soon as possi- 
ble, alkali in some form, such as baking-soda 
or sodium-bicarbonate in warm water for the 
child to drink. It not only helps to wash out 
the stomach but some of the alkali is absorbed 
into the system which is desirable in correcting 
the acid state. Milk of magnesia is also an alkali, 
and it is a wise plan to continue giving small 
doses of this for several days, using twenty to 
thirty drops in the milk or water for babies 
once or twice a day, of one teaspoonful for chil- 
dren after the fifth year, given twice a day. The 
enema of bi-carbonate of soda which I recom- 
mended also introduces alkali into the system. 

THE PKEVENTION 

In babies the prevention of food poisoning 
depends entirely upon clean milk. The bottle- 
baby, during the summer months, must have Pas- 
teurized milk or boiled milk. This renders it 
safe if the bottles and nipples are kept carefully 
sterilized by boiling. Not one detail in this care 



FOOD POISONING 221 

can be omitted. The breast-baby rarely has sum- 
mer diarrhea. 

Heat has a decidedly depressing effect upon a 
child's vitality and therefore is an important 
factor to be dealt with. The power of digestion 
during the hot weather is lessened, thus it is 
a wise plan to reduce the strength of the baby's 
food about one-third, making up the amount of 
the feeding by adding water which has been 
boiled. 

The food of the older child must be just as 
carefully prepared and apportioned. No under- 
ripe or over-ripe fruit should ever be permitted. 
When foods first come in season such as green 
corn, peaches, melons, apples, the child's stom- 
ach should be very gradually accustomed to 
them. We have already discussed the precau- 
tions about cooking and keeping food, and during 
the hot days the child should not be allowed to 
eat as heartily as usual or to eat between meals 
and should be especially urged to drink four or 
five glasses of water daily between meals, while 
babies should have a nursing bottle of cooled 
boiled water regularly between feedings. 

The clothing of the baby and the older child 
must be light weight during the hot days. A 
diaper and slip are all that are needed for the 
baby. He should be kept out of the sun, in a 
cool place and -where the air is in circulation, 
but not in a draught, because sudden chilling of 



222 DISEASES OF INFANCY 

the body may bring on diarrhea. On very hot 
days don't neglect to sponge the baby's body 
with a little cool water, and let the water evap- 
orate on the skin. This will take up a lot of 
the body heat. 

Never let the older children wear hot, closely 
woven underwear during the warm weather. 
Encourage them to remain quiet in cooler places 
during the heat of the day. Screen the rooms 
well and have the windows wide open day and 
night. Encourage them to sponge their bodies 
with tepid water just before retiring. And as a 
final warning, keep flies out of the house and 
away from all the food. 






CHAPTER XXI 
TYPHOID FEVEK 

I believe it valuable to preface this chapter 
on typhoid fever by quoting from an eminent 
authority on the means of its prevention. "If 
house drainage were always perfectly carried 
out, sewage satisfactorily disposed of, water- 
supply efficiently protected or treated, patients 
segregated, and the typhoid material excreted 
by them and by typhoid "carriers" effectually 
annihilated — if, in short, scientific cleanliness 
were completely attained, the disease would dis- 
appear, or be at least excessively rare." 

Typhoid fever is an acute infectious disease 
most common in adult life, rare in infancy and 
early childhood, but more frequent as puberty 
approaches. It occurs in single cases and in 
epidemics. It is caused directly by the typhoid 
germ which enters the system through the 
mouth, usually in water, milk or contaminated 
food, and attacks first the lining of the small 
intestine and from there may be carried to 
other organs of the body. 

The seat of the disease is in the small glands 

223 



224 DISEASES OF INFANCY , 

distributed along the lining of the intestines 
which become greatly swollen as they are 
attacked by the germs. As the disease pro- 
gresses the swollen spots form into ulcers and 
the tissue is sloughed away. There may be few 
of these ulcers or they may form in great num- 
bers and in serious cases eat deeply into the 
walls of the intestine breaking open blood ves- 
sels and causing hemorrhages. In very serious 
cases one of these ulcers may eat entirely 
through the intestine, producing a perforation 
which allows the contents of the bowel to leak 
into the abdominal cavity producing a serious 
and usually fatal peritonitis. 

As the disease improves the ulcers heal and 
form scars. Oftentimes they are not entirely 
healed when the child gets out of bed after the 
illness and a little carelessness in diet commonly 
brings on a relapse. 

From the time that the infection is taken into 
the system to the time the fever actually devel- 
ops one to two weeks elapse. In the usual case 
the first symptoms are headache, tiredness, desire 
to lie around, poor appetite, sometimes vomit- 
ing, and often a diarrhea, although some chil- 
dren coming down with typhoid fever are, on 
the contrary, very constipated. 

Toward evening the skin feels hot and one 
and one-half, two or even more degrees of fever 
will be found. The careful mother will give such 



TYPHOID FEVER 225 

a child a cathartic thinking the stomach upset 
(which is the right thing to do) and in the 
morning she will, as a rule, find the temperature 
down nearly to normal. But as the day wears 
on the fever comes up again in the afternoon, 
and as night approaches is a little higher than 
on the preceding day. The face will be slightly 
flushed, the eyes quite bright, and the child rest- 
less at night. No further delay should be made 
in notifying your physician. The next morning 
the temperature will again have dropped, but 
will continue to rise throughout the day until 
at night it is still higher than on the previous 
night. So on day by day, the temperature 
mounts a little higher each night, dropping one 
or two degrees during the early morning hours. 
This step-like process of the fever continues 
for a week or ten days and then will come sev- 
eral days when the fever runs up in the after- 
noon and down in the morning at a high uniform 
temperature.. For example, during this stage 
the fever may vary at night from 102° to 104° 
F. or even more, and in the morning from 100° 
to 102° F. or more. This period continues until 
the twenty-first to twenty-eighth day after the 
first outbreak of the fever; then by much the 
same step-like process as that by which it 
mounted, the fever will subside, or the descend- 
ing fever may run along, with intermittent spurts 
for three weeks or a month or even longer. 



226 DISEASES OF INFANCY 

It is during this time when the temperature is 
coming down to normal that relapses commonly 
occur. 

The only other characteristic symptoms that 
the mother will be able to see are the distended 
abdomen which is always more or less promi- 
nent in typhoid fever, and the little rose colored 
spots which usually appear on the abdomen and 
sometimes over the front of the thighs the sec- 
ond week of the fever. In children these spots 
are not always present but when they do appear, 
are very characteristic. They may be slightly 
elevated and when pressed with the finger lose 
their color for a moment. They generally 
appear in successive crops and do not itch or 
cause discomfort. In serious cases the disten- 
sion of the abdomen may be very great. Most 
all typhoid fever patients have a dry mouth 
and coated tongue with the brownish accumula- 
tion on the teeth called sordes. 

There are other symptoms which the child 
may have, but which can also occur in other 
diseases, such as cough with bronchitis which 
very commonly accompanies typhoid fever. This 
weakness of the lung must keep the mother con- 
stantly on guard against pneumonia of which 
there is always danger. Some children are 
extremely restless, tossing about and becoming 
delirious, with high fever, especially late in the 
day. Others will be dull, stupid and apathetic. 



TYPHOID FEVER 227 

Your physician will find upon examination 
that the spleen is enlarged and he will also make 
the definite blood test known as the Widal test. 
This is positive proof of the presence of typhoid 
fever, but it can only be made after the fever 
has been present for several days. The blood 
of a typhoid fever patient is constantly manu- 
facturing anti-toxin which destroys the typhoid 
bacilli. It is this process going on in the blood 
which enables the patient to throw off the dis- 
ease. In the Widal test active typhoid germs 
grown in a laboratory are mixed with a drop 
of blood of the patient and examined under a 
microscope. These germs are in constant rapid 
movement. 

If the patient's blood has no effect upon the 
moving germs, the blood contains none of the 
anti-toxin which is always present in typhoid 
fever. If the patient's blood causes the germs 
to cease their activity it is a sign that the anti- 
toxin is present in the blood and the patient is 
consequently suffering from typhoid fever as 
this typhoid anti-toxin is never present unless 
the typhoid germs have gotten into the system. 

There are many variations from the typical 
not only in the symptoms but in the course of 
the disease. This is especially true of typhoid 
in babies and young children and it is then often 
difficult to determine whether the disease is 
typhoid until a sufficient number of days have 



228 DISEASES OF INFANCY 

elapsed to allow the Widal test. In young chil- 
dren the temperature, instead of mounting in 
the regular step-like course, may be extremely 
irregular; the first symptoms noticed may be 
convulsions although they are not the rule. The 
mother many times thinks the baby coming down 
with typhoid fever has indigestion or that the 
bowels are out of order, and it is often only 
after the fever has continued for several days 
that a suspicion of typhoid is aroused. 

There is a mild type of typhoid fever which 
does not run the full course, but is much shorter 
with symptoms less severe. Children during 
the run-about age quite commonly have this 
mild form of typhoid. The older the child and 
the nearer the approach to puberty the more 
severe do the attacks become. 

Bright red blood in the bowel movement is a 
sign of hemorrhage which demands your physi- 
cian's immediate attention. Great pain in the 
abdomen, a state of collapse with rapid pulse, 
and sunken pinched expression of the face with 
sudden rapidity of breathing are equally critical 
signs which demand his prompt attention as it 
may indicate that one of the ulcers in the intes- 
tines has eaten through the wall of the bowel. 

The live germs of typhoid are found in the 
bowel movements and in the urine and may 
exist in the sputum if bronchitis accompanies 
typhoid fever. This has a very important bearing 



TYPHOID FEVER 229 

on the question of disinfection necessary during 
the treatment. The typhoid bacilli may live for 
weeks, months and even years in the intestinal 
tract, most probably in the gall bladder, of one 
who has had the disease. 

Other means of communicating typhoid fever 
are through water contaminated from leaking 
sewers, or wells that are so located that they 
receive the seepage of out-houses. Because 
one who has had typhoid fever can carry the 
live germs in the intestines for many years it 
is easy to understand how any of their excreta, 
can contaminate water and the disease be spread 
to whole communities. Typhoid is carried in 
milk from contaminated water used in cleaning 
the cans, or from some helper who has had the 
disease and is still a "carrier" communicating 
the disease by soiled hands or by polluting the 
water that is used in and about the milk. 
Typhoid bacilli live in soil that is poorly 
drained, especially soil near cess-pools or kept 
contaminated by old leaking sewers. Flies carry 
the infection from unprotected out-houses to 
food. It is sometimes carried in raw vegetables 
from the soil that is polluted, and in oysters and 
shell-fish taken from places where sewers open. 

If you live in a community where there has 
been an outbreak of typhoid fever, boil the 
water and the milk until the source of the 
trouble is discovered. If any member of your 



230 DISEASES OF INFANCY 

family has had typhoid fever in recent years he 
should make a trip to the nearest city laboratory 
to ascertain by examination of the urine and 
feces whether he or she is a carrier of the dis- 
ease. Such a carrier can be responsible for an 
epidemic of typhoid fever. 

Complications. — During the course of the 
attack a complication which may occur is pneu- 
monia. This is because of the fact that bron- 
chitis is so commonly present in typhoid. Even 
after an attack the lungs may not regain their 
strength for some time. If there are any tuber- 
cular tendencies they are liable to manifest 
themselves at this time. One of the legs may 
be left in a swollen condition due to a plugging 
of the veins from a clot resulting from the 
inflammation. Sometimes speech leaves the 
child for a number of days or weeks, and nose- 
bleed may be extremely serious. 

THE TBEATMENT 

Vaccines to prevent typhoid fever are now 
being used with great success. The results as 
demonstrated in the army during the Great 
War, leave no question as to their efficiency in 
preventing this disease. Typhoid fever was 
almost unknown in this war while in all wars of 
the past it has been very prevalent. Anyone 
going into a community where typhoid has 
broken out should be inoculated before running 



TYPHOID FEVER 231 

the risk of exposure, as should all those in the 
community or neighborhood where it appears. 

Typhoid fever in the child may mean less than 
a week of illness or it may mean three to six 
weeks. He should be kept in bed no matter 
how mild the attack. The sick-room manage- 
ment as laid down in the first chapter should 
be followed. The cleansing sponge bath should 
be given twice a day without exposing the body. 
A mouth-wash of Listerine or boric acid solu- 
tion should be used three times a day, and 
teeth and lips should be carefully cleansed with 
clean gauze dipped in the solution. 

The diet should consist at first largely of 
gruel made from the cereals. Oatmeal, rice, 
Farina or Cream of Wheat can be used. Thor- 
oughly cooked and strained oatmeal is especially 
nourishing, and the child will often take this 
with butter and sugar or a little corn syrup 
when the oatmeal flavor becomes unpalatable. 
Lamb or chicken broth and strained vegetable 
soups are valuable for nourishment. Drinks of 
malted milk, lemonade, very weak tea, and 
orangeade are to be used. Kumyss and butter- 
milk are excellent if the child will take them. 
Water sherbets flavored with orange or peach 
juices and orange juice with sugar and the white 
of egg stirred in, are tempting, and the child 
should be encouraged in every way to drink plenty 
of water between meals. Toasted whole-wheat 



232 DISEASES OF INFANCY 

bread and butter or zwieback can be given. 
With such a variety of foods, nourishment can 
be kept up without over-feeding. During con- 
valescence, a little scraped or minced beef may 
be given, according to age, with a poached egg 
on toast, small portions of well-cooked vegeta- 
bles, junket, custards, tapioca pudding and fruit 
juices. (Raw vegetables and raw fruits should 
be omitted as these are sometimes the carriers 
of the disease.) 

A milk diet is often advocated in typhoid 
fever cases but foods containing protein, such as 
milk, meat and eggs, and foods containing fat, 
have been seen in many cases to prolong the 
fever and distend the abdomen. The disease 
will be much more easily managed and more 
quickly terminated if you avoid these foods 
until the fever is over, depending upon the 
gruels and other foods mentioned for nourish- 
ment. 

Disinfecting. — The bed clothes and those of 
the patient should be changed daily and should 
be put at once in boiling water and boiled fifteen 
minutes. The urine and feces should be received 
in vessels containing a 1 :1000 solution of bichlo- 
ride of mercury. Babies wearing diapers should 
use pieces of muslin or cheese cloth that can be 
burned as soon as soiled. The nurse or attend- 
ant changing the baby, handling the recepta- 
cles, or tending the patient should carefully 



TYPHOID FEVER 233 

scrub their hands after each handling. The pro- 
tecting dress or apron worn should be boiled 
when soiled. 

Controlling the Fever. — Some children bear 
a high temperature well; with some a high tem- 
perature brings on extreme restlessness. When 
the fever makes the child nervous and sleepless, 
the cool sponge (one-third alcohol and two-thirds 
water) will usually promptly lower it. Leave 
the water on the skin to evaporate. If this does 
not reduce the fever, on the physician's advice 
the child can be lifted into the bath-tub, the bath 
being warm at first and gradually cooled by 
adding cold water until it reaches 85° F. The 
skin should be rubbed constantly to keep up a 
gentle friction and towels wrung out of cold 
water and an ice-cap should be kept on the head 
during the bath. Cold towels placed on the head 
during the day when the fever is annoying will 
occasion much relief. Cold packs as a means of 
relief should never be given except on your phy- 
sician's advice. 

At any time during the attack stimulants may 
be required because of the weakness of the heart 
or the great prostration from the fever and the 
prolonged illness. Your physician will prescribe 
the right stimulants for you to use. Brandy, 
one-half teaspoonful for a child of three and one 
teaspoonful for an older child, acts well in stim- 
ulating the heart of a greatly depressed patient. 



234 DISEASES OP INFANCY 

It can be given in a little water and the dose of 
this stimulant may be repeated every two or 
three hours if necessary. 

A cathartic should only be given under your 
physician's advice, except in the very beginning. 
The bowels can be kept open by soap-suds 
enemas. A few drops of turpentine put in the 
water used as an enema will allow much of the 
gas, which is so uncomfortable, to escape. Flan- 
nel cloths wrung out of hot water and turpen- 
tine (one-half teaspoonful of turpentine to the 
quart of water) and applied very warm over the 
abdomen will help to relieve the child of the 
uncomfortable distension. 

If vomiting occurs promptly reduce the quan- 
tity of food. If you do use milk, add a little 
bicarbonate of soda or peptonize the milk. The 
milkless diet which was suggested will do away 
with much of the vomiting. Diarrhea may at 
times become severe and your physician will 
have to give something to check it. At times 
the mouth may become sore and must be 
cleansed each time food is given, but this is 
rare when the mouth is carefully tended as 
directed. The sick child should not be allowed 
to lie continually flat on its back but should 
be turned from time to time to prevent bed 
sores, and the back should be rubbed with alco- 
hol to harden and cool the skin. The sheets 
under the patient must be kept perfectly smooth 



TYPHOID FEVER 235 

as any wrinkling only furthers the condition of 
bed-soreness. 

If there is bleeding from the bowels, which 
is not common in young children, notify your 
physician at once. Eaise the foot of the bed 
about two feet and put ice-cloths or an ice-bag 
over the abdomen. 

Any complications, such as pneumonia, infec- 
tion of the middle-ear and nose-bleed must be 
treated according to the directions laid down in 
the chapters dealing with these conditions. 
Typhoid fever leaves a child greatly debilitated 
and there is a long period of convalescence the 
rules for which are given in the first chapter. 



'CHAPTER XXII 

THE KIDNEYS AND BLADDER 
bkight's disease 

This is an inflammation of the kidney which 
injures its secreting structure so that valuable 
food products, such as albumin, are allowed to 
seep out into the urine instead of being retained 
in the blood for nourishment. 

The poisons of disease circulating in the blood 
are the cause of this inflammation of the kidneys. 
The poisons thrown off by the bacilli which cause 
diphtheria, scarlet fever, pneumonia, in fact any 
of the acute infectious diseases, {acute tonsillitis 
and rheumatism, cause Bright 's disease. It can 
also develop after exposure to cold and wet and 
appears in some cases where no cause can be 
traced. 

In describing the acute infectious diseases ref- 
erence has been repeatedly made to the develop- 
ment of Bright 's disease during the course of 
an attack and it is for this reason that repeated 
examinations of the urine are made by the phy- 
sician, because Bright 's disease can develop while 
a child is acutely ill and not be recognized. How- 

236 



THE KIDNEYS AND BLADDER 237 

ever, in many cases the eyelids become puffy, 
the face, hands and feet swell. At other times 
a child will be progressing favorably in the course 
of one of the diseases we have named when sud- 
denly the fever flies up, the child vomits, has 
headache and an attack of Bright ? s disease. The 
child may have these same symptoms when the 
attack of Bright 's disease occurs independent of 
any other sickness. At times, however, it comes 
on so gradually and without any alarming symp- 
toms, that it is not discovered until an examina- 
tion of the urine happens to be made because the 
child has been ailing, a little below par and not 
looking well. 

The urine generally becomes scanty and high 
colored and upon examination shows albumin and 
casts, although only albumin may be present. One 
of the possible symptoms in Bright disease is 
dropsy. Many cases of acute Bright 's disease 
last only a few days or a few weeks, but there is 
always the danger that it may pass into the 
chronic type. 

Treatment. — During all the acute infectious 
diseases of childhood it is important that the kid- 
neys be given as little work as possible. The skin 
must be kept active by daily warm sponge baths ; 
the child should be kept warm in bed and never 
endangered by draughts, or the body needlessly 
exposed to cold when bathing. The bowels must 
move every day and the alkaline cathartics should 



238 DISEASES OF INFANCY 

be given, such as milk of magnesia, citrate of 
magnesia or Epsom salts. As the skin, bowels, 
kidneys and lungs are the four avenues by which 
the waste matter is gotten out of the system, this 
attention to the skin and bowels, and plenty of 
fresh air day and night in the sick-room are the 
first means to relieve the kidneys in a case of 
Bright 's disease. 

The diet during the fever should always be 
light, consisting of milk, buttermilk and gruels. 
Water must be taken freely so that the kidneys 
are kept flushed and the poisons carried off. This 
may be all that is necessary to carry the child 
successfully through an attack of Bright 's disease 
which develops during one of the acute infectious 
diseases. On the other hand, in more severe 
attacks, it may be necessary for your physician 
to prescribe something to stimulate the action 
of the kidneys and if during a case of Bright 's 
disease a child is taken with severe headache, 
nausea and vomiting, or with convulsions, your 
physician must be sent for at once as this 
often means that uremic poisoning has developed, 
and it is then going to be necessary to produce 
sweating by placing the child in a very hot bath 
and wrapping him in blankets to continue the 
sweating. The physician will give nitro-glycerin 
as soon as possible. Such an attack calls for 
immediate and energetic treatment as it may 
prove fatal. 



THE KIDNEYS AND BLADDER 239 

Until the albumin has disappeared from the 
urine it is best to keep the child in bed. Beturn 
to the regular diet must be slow and salt must 
not be used in the cooking or given on the foods. 
Milk and buttermilk should be an important part 
of the diet. Stewed fruits and juices of raw 
fruit are very valuable. Cereals, bread, butter, 
sugar, some of the green vegetables (except beans 
and peas) and as the child continues to improve, 
cheese and fresh eggs can be added. Vegetable 
soup and any of the cereal gruels can be given. 
After the improvement has continued for a few 
weeks with no sign of albumin in the urine, add 
mutton and chicken broth to the diet, then a little 
well-cooked beef, and later mutton and chicken. 
Throughout this time the physician keeps up the 
repeated examinations of the urine as a precau- 
tionary measure. 

If acute Bright's disease becomes chronic this 
same diet outline will have to be carefully fol- 
lowed, omitting salt in all cooking if the swelling 
continues in the face, hands or feet. Keep the 
child dressed warmly and do not let him be 
exposed to damp or cold weather. Give the warm 
bath daily. 

If the disease persists take the child to a 
warm climate for four or five months if pos- 
sible. Iron tonics, such as Basham's Mixture, 
are to be recommended because Bright 's disease 
often leaves a child very anemic. 



240 DISEASES OF INFANCY 

PUS IN THE KIDNEYS 
PYELITIS 

Each kidney has what is known as the pelvis 
which is a sac-like structure through which the 
urine drains in passing to the bladder. Not 
uncommonly in young children, especially babies 
and particularly girl babies, an infection gets 
into this pelvis and forms pus. The infection 
may be carried to it from the blood or travel up 
from the bladder. The baby will have fever, 
usually high and very irregular, running high 
for a few days, running normal for a few days 
and then flaring up again. There may be no 
further symtoms other than a poor appetite. 
Some vomit occasionally, some have a little diar- 
rhea, others constipation. I'he things that dis- 
tress the mother are the fever and frequent uri- 
nations which many times burn and excoriate 
the skin. 

If you have a child who is running such a fever 
with no apparent cause, always have the urine 
examined for pus. Many times this accounts for 
the trouble. You will then have to give the baby 
more water and the physician will prescribe some 
alkali, usually potassium acetate combined with 
sodium bicarbonate, in suitable doses for the age 
of the child and continued over a long period of 
time, because it is many times difficult to rid the 
pelvis of the kidneys of all the pus and the child 



THE KIDNEYS AND BLADDER 241 

will appear to be all right and then have a return 
of the symptoms. The treatment should be con- 
tinned until repeated examinations show that no 
pus is present. The older child must be put on 
a milk and gruel diet and given the same treat- 
ment. 

INFLAMMATION OF THE BLADDER 
CYSTITIS 

This condition in children is due to an infec- 
tion getting into the bladder, setting up an inflam- 
mation causing pus. It occurs most commonly 
in connection with some acute infectious disease, 
especially typhoid fever. When the infection is 
in the pelvis of the kidney the bladder is also 
often affected. Another cause may be severe 
chilling of the body. The first signs the mother 
notices are a little fever, loss of appetite, and 
urinating in very small amounts eyery few min- 
utes. The child will cry at these times or if old 
enough will complain of pain when urinating and 
the burning and irritation of the skin. If the 
mother presses down over the bladder (just 
above the pelvic bone) the child will com- 
plain of its being sore. A specimen of the 
urine should immediately be taken to the physi- 
cian for examination for the presence of pus. 
If inflammation (cystitis) is present the child 
had better be put to bed for a few days, kept 
warm and quiet, given lots of water to drink 



242 DISEASES OF INFANCY 

and a diet of milk or buttermilk. The milk can 
be diluted with Lithia water and Lithia water 
given to drink. It is a good plan to put in each 
glass of milk a pinch of bicarbonate or baking 
soda. This also supplies alkali as does the Lithia 
water which is needed in this condition. The 
bowels should be kept open by giving the milk 
of magnesia which is an alkali cathartic. Your 
doctor will prescribe urotropin to be taken inter- 
nally three or four times a day, well diluted with 
water. Use two grains for a child under three 
years of age, four grains for a child from three 
to six, at each dose. If there is a great deal of 
pain from the bladder at the time of urination, 
cloths wrung out of very hot water can be placed 
over the lower abdomen. The treatment should 
be continued until all the pus has disappeared 
from the urine. 

BED-WETTING 

Inability to control the urine occurs in some 
children both day and night. Most children have 
gained control of the bladder by the time they 
are two years old. Occasional lapses are not 
unusual but if continued bed-wetting occurs, the 
cause must be looked for. In boy babies if the 
foreskin is adherent so that it cannot be retracted 
and kept clean circumcision may be necessary. 
In girl babies if there is any leucorrhea it must 
be treated as directed later under Vaginal Dis- 



THE KIDNEYS AND BLADDER 243 

charges. The child must not be constipated and 
if no movement has taken place during the day, 
before bedtime an enema must be given. 

Worms are a cause of bed-wetting. A dose 
of castor oil should be given and the bowels 
watched the next morning for any signs of 
worms. The irritation caused by enlarged ade- 
noids or tonsils will cause bed-wetting but the 
most common cause is error in the child's diet. 
Eating between meals, irregular meals, fried 
foods, lots of sweets, candy and pastry are 
responsible in many cases. Too much milk to 
drink or milk too rich must be avoided. After 
the second year the child should have no more 
than three or four cups of milk a day, preferably 
with the meals, drinking only water between 
meals and having nothing to drink after four 
o'clock in the afternoon except a few sips of 
water to relieve actual thirst. The directions 
for diet under Intestinal Indigestion should be 
followed. Bed-wetting is very common in the 
nervous child and the one allowed to get over- 
tired during the day ; especially in the one 
fatigued and made nervous by school work. In 
some children lack of development of the thyroid 
gland causes this condition, as also does cystitis 
or any inflammation of the bladder. 

All these sources of the trouble must be studied 
and removed. There should be three regular 
meals a day and the supper should be light 



244 DISEASES OF INFANCY 

with no fatiguing play afterward. The nerv- 
ous child should rest for an hour or two dur- 
ing the middle of the day, and the one who can- 
not control urination should not be made to go 
to school because the nervousness caused by fear 
of ridicule will only aggravate the trouble. This 
is true of scolding and punishments. 

The child should be encouraged to do all he 
can by your kindly suggestions that he is going 
to conquer this trouble. An eminent specialist 
in the diseases of children holds that the value 
of suggestion is very great; that if you will say 
kindly and firmly to the child as he is going to 
bed: "You are not going to wet the bed tonight," 
and have him repeat after you: "I am not going 
to wet the bed to-night, " saying this several 
times not only at night but during the day, you 
will find in many cases the suggestion will work 
wonders. He further says that in some cases 
he has known the suggestion whispered to the 
child in a state of natural sleep, to be of service. 

Encourage the child to sleep on his side, cover 
with light-weight but sufficiently warm bedding, 
have plenty of fresh air, and take him up even if 
asleep at ten o'clock, or when you retire, in order 
to empty the bladder. Do this every night and 
the child will in most cases be able to go through 
the night successfully. The physician may find 
it necessary to prescribe small doses of nux 
vomica or strychnine, at times combined with 



THE KIDNEYS AND BLADDER 245 

small doses of belladonna, three times a day. If 
he is suspicious that the thyroid secretion is 
deficient he will prescribe small doses of thyroid 
extract. 

The mother must remember that these various 
causes which make bed-wetting a habit, when 
removed do not also remove the habit itself which 
lias been formed and this must be dealt with 
often for a long time with patience and 
perseverance. 

VAGINAL DISCHAKGES 

Little girls, and not uncommonly girl babies, 
develop a leucorrheal discharge from the vagina 
which always causes the mother great anxiety 
and which is important to check as quickly as 
possible as it may lead to masturbation. It is 
liable to develop after severe illness, especially 
after one of the acute infectious diseases, or if 
the general health is run down. Pin worms may 
crawl forward from the rectum into the vagina 
and set up an inflammation which produces leu- 
corrhea. At times a more serious infection may 
be introduced from toilet seats not kept thor- 
oughly clean or from soiled towels in public 
places, at school or elsewhere. 

The mild leuchorrhea can be promptly gotten 
rid of in most cases by the sitz bath. Put one 
tablespoonful of alum in a wash-bowl of water, 
or use two teaspoonfuls of boric acid crystals 



246 DISEASES OF INFANCY 

which have been dissolved first in boiling water, 
and have the child sit in this for fifteen minutes 
twice a day. Gently wash the external parts in 
this solution with a soft cloth before the child 
retires. If the leucorrhea doesn't clean up in two 
weeks time obtain a glass catheter (female), 
attach to your fountain syringe and with a quart 
of warm boric acid solution (two teaspoonfuls of 
the crystals to the quart of water) and give a 
douche. Have the child lie in the bath-tub and 
introduce the glass catheter very gently just a 
short way into the vagina. To be effective this 
douche should be given three times a day. 

In severe infections, it may be necessary to 
secure from your druggist powders of potassium 
permanganate crystals. Have the powders put 
up so that one powder in a quart of water makes 
a one to five thousand solution. Use this in a 
douche in the same way as the boric acid solution. 

Always look for the presence of pin- worms (as 
previously directed) and do not allow any con- 
stipation to exist. 



CHAPTER XXIII 
DISEASES OF THE SKIN AND NERVOUS SYSTEM 

ERYSIPELAS 

Erysipelas is an infection caused by the 
streptococcus germ which gets into an abrasion 
or a wound and travels beneath the skin. It is 
a possibility that the surgeon always dreads in 
a wound. A common starting place is the edge 
of the nostrils where the skin has been lacerated 
by the finger-nails, or the inner corners of the 
eyes. 

As the germ travels forward beneath the skin, 
the skin becomes swollen, raised, red, hard and 
tender to the touch. Erysipelas progresses like 
a prairie fire, involving larger and larger areas of 
skin. As it creeps forward the inflammation at 
the starting point begins to subside, the skin 
flattens down to normal, usually with a little 
yellow tinge, then follows the natural color and 
superficial scaling. 

When erysipelas starts the child will feel sick, 
act languid, may have a chill. A fever begins 
which mounts higher and higher, sometimes to 
105° F. and there is great prostration. As the 

247 



248 DISEASES OF INFANCY 

disease spreads there is always danger of its 
becoming fatal because when it reaches the scalp 
it may be carried into the covering of the brain, 
producing meningitis. It may extend into the 
lining of the nose and mouth, producing severe 
and dangerous swellings which interfere with 
breathing. 

If there is any suspicion of erysipelas the child 
must be put to bed and isolated except from the 
one person who is to act as nurse because the 
germ can get on the skin of another person and 
there set up an erysipelas. Disinfect all clothing, 
and bed-clothes as described in the first chapter. 
Paint profusely the healthy skin extending at 
least two inches beyond and around the inflamed 
spot, making a complete circle, by using tincture 
of iodine with a cotton swab. This is to keep 
the germ from spreading. Send for your physi- 
cian at once; if he cannot get there immediately 
have your druggist put up an ointment of twenty- 
five per cent ichthyol in vaseline. Spread this 
thickly on muslin or gauze and lay all over the 
inflamed part. Change it, putting on fresh oint- 
ment and gauze every three hours. 

If you cannot get the ichthyol immediately, dis- 
solve all the boric acid crystals that will be taken 
up in a quart of boiling water ; wring out lint or 
gauze (as hot as the child will bear) from this 
solution, extend them well over the inflamed area, 
and change every fifteen minutes. Thoroughly 



THE SKIN AND NERVOUS SYSTEM 249 

wash your own hands after each handling of the 
patient. Flood the room with fresh air. This is 
important in erysipelas. 

To give nourishing foods is also an important 
measure. Give custards, soft eggs, junket, cream 
and milk toast, well-cooked wheat cereals, scraped 
beef and mutton slightly under-done. Give plenty 
of rich milk if the child takes it well, also beef 
and mutton broths and plenty of water. Young 
babies should receive their full milk feedings. 
It is essential to keep up nourishment. 

Many authorities believe that brandy, five to 
ten drops for a child under two in two-hour 
doses, and ten to twenty-five drops for a child 
from two to five, and thirty drops for older chil- 
dren, is very valuable in checking the disease 
and should be given from the beginning and kept 
up until all signs of the disease have disappeared. 
The bowels must move thoroughly each day. 

ECZEMA 

Eczema is by far the most common skin dis- 
ease in infancy and childhood, and is an inflam- 
mation which appears in many forms. We have 
the dry, scaling eczema in slightly raised flat 
reddened surfaces, and the small distinctly ele- 
vated reddened pimples, closely crowded. Again, 
the inflamed area may contain little pimples filled 
with pus ; or it may be constantly moist with - 
little crusts forming over the moist spots. The 



250 DISEASES OF INFANCY 

child may be afflicted with two types at once. 
These places are extremely irritating and by 
constant scratching are infected with the finger- 
nails. In babies eczema may be the result of 
some outside irritation, strong soaps, coarse 
clothing next the skin, wet or soiled diapers, or 
acid stools from too much fat or sugar in the 
food. It is sometimes caused by exposure to 
cold winds and sometimes to lack of proper 
bathing and cleanliness. The most common cause 
is improper diet, very often some one element in 
the food which does not agree. In the nursing 
baby the mother's milk may be too rich in 
fat; in the bottle baby the mixture may be too 
rich in cream or may have too much sugar added; 
or the baby's tolerance for one or the other of 
these elements be limited. Eczema is very com- 
mon in babies who are healthy and well in every 
other way. Eczema developed during the first 
year usually disappears during the second year 
when the baby begins taking other food in addi- 
tion to milk. Do not wean the breast baby who 
is thriving, even though you cannot clean up the 
eczema entirely. 

Keep your own bowels well open by taking 
preferably, milk of magnesia or fifteen to thirty 
grains (% to y 2 teaspoonful) of Husband's mag- 
nesia two hours after eating. This will keep 
your bowels open and reduce any acid state of 
your system which might be responsible for the 



THE SKIN AND NERVOUS SYSTEM 251 

eczema in the baby. If your baby is well nour- 
ished, eat meat three times a week, eggs once a 
day, and use a very small amount of cream. 
Before each nursing, put a pinch of ordinary 
baking soda in an ounce of boiled water and give 
from a nursing bottle. Do not allow constipa- 
tion in the baby; give one or two teaspoonfuls 
of Nujol or Interol at bedtime or enough milk 
of magnesia to keep the bowels open. If the 
baby is bottle-fed try removing part of the 
cream. You may have to remove all the cream 
for a few days and feed skimmed milk properly 
modified for the age. Have your druggist put 
up small powders containing three grains of 
sodium bicarbonate in each powder; dissolve one 
of these in each nursing bottle. Give the same 
laxative as just advised to keep the bowels open. 
If the eczema does not clear up by removing the 
fat try reducing the sugar as this may be the 
fault. If the eczema develops during the latter 
part of the first year it may be due to the orange 
juice or the beef juice. Remove first one then 
the other to discover the fault. After the eighth 
month the pulp of well-cooked vegetables, such 
as spinach, carrots or asparagus tips, put through 
a colander, can be given; using two or three tea- 
spoonfuls a day. 

At night gently restrain the baby's hands by 
pinning the sleeves of the night-gown to the 
mattress so that he cannot scratch himself. Do 



252 DISEASES OF INFANCY 

not rise any water over the affected parts, but 
cleanse them with olive oil. Keep the diaper 
clean and dry and wash carefully the buttocks 
and thighs after each bowel movement. Use a 
very soft cloth, water and a little castile or 
resinol soap. Apply to the eczema spots an oint- 
ment of zinc oxide in which the druggist puts 
ten per cent of white wax. Cover with clean 
pieces of lint. Over this pin the diaper and 
change each time the diaper is soiled. Always 
cover the ointment with the pieces of lint or 
old cotton so that the urine does not soak off 
the ointment. On the other parts of the body 
use the plain zinc oxide ointment. If the eczema 
is the moist or "weeping" type have the drug- 
gist put in the ointment one-third powdered 
starch. In the more stubborn forms of eczema, 
resinol ointment will be of more service than 
zinc oxide. If the spots are bad on the face, 
make a linen cloth mask cutting holes for the 
eyes and nose and mouth. Tie this over the 
face after applying the ointment well and cover- 
ing with pieces of lint. 

In older children, after the first year, look 
first to sugar as a possible cause for the eczema. 
Children who have been allowed quite a little 
candy often have this trouble and it is sometimes 
necessary to' omit all sugar from their food for 
a time. Some children have intestinal indiges- 
tion from such foods as meat and eggs and some- 



THE SKIN AND NERVOUS SYSTEM 253 

times from an excess of milk. Refer to the article 
on intestinal indigestion in a preceding chapter 
and study your child's case according to the 
suggestions given there. This will help locate 
the - cause. Acid fruits such as strawberries, 
grape fruit, and oranges may cause eczema and 
must always be thought of as a possible source 
of the trouble. Too much meat or meat juice is 
sometimes the cause. You will have to experi- 
ment a little with the child's diet because the 
foods that are to blame with one child may not 
be with another. 

These children should receive a powder con- 
taining sodium salicylate and sodium bi-carbon- 
ate; two grains of each for children from the 
second to the fifth year; three grains of each 
for the child after the fifth year, given after 
each meal. All the water possible should be 
drunk between meals. The meals should be 
given regularly and carefully prepared. All 
cooked green vegetables are most beneficial in 
these cases. Follow out the general suggestions 
for rest and hygiene given in the chapter on mal- 
nutrition. The treatment of bathing and the use 
of ointments is the same as advised for babies. 

Shingles or Herpes. — These are painful little 
blisters appearing on the chest or the side of 
the abdomen along the course of the nerves. 
They are due to some infection that gets under 
the covering of the nerves. Put the child to 



254 DISEASES OF INFANCY 

bed, paint the blisters with collodion, and give 
castor oil to open the bowels. Keep the child 
quiet in bed on a soft diet until the blisters 
dry tip. 

HIVES 

Hives is an inflammation of the skin which 
appears in raised red blotches which may or 
may not have a whitish center resembling a mos- 
quito bite. The skin may begin to itch before 
the blotches appear. They are almost always 
due to the poisons from some food which does 
not agree with the child, commonly buckwheat, 
oatmeal, eggs, tomatoes, strawberries, lobsters 
or crabs. They very commonly follow an injec- 
tion of antitoxin for diphtheria, and if a child 
is subject to attacks of hives the physician should 
be told before giving antitoxin. Certain drugs 
taken internally, especially arsenic and quinine, 
bring out hives on some children. Bites of 
insects,, and very commonly sand-flies, are 
responsible. Children acutely ill with infectious 
diseases will occasionally break out with hives. 

There will have to be a little experimenting 
with the diet to see what article of food is caus- 
ing the hives. As soon as they appear the bowels 
must be emptied by giving rhubarb and soda or 
milk of magnesia repeated several days until 
the hives have disappeared. The child should 
be put on a diet of lamb and chicken broth and 






THE SKIN AND NERVOUS SYSTEM 255 

gruels and some stewed fruit, omitting milk for 
a few days. Give sodium bi-carbonate and 
sodium salicylate internally in the doses recom- 
mended for eczema. Intestinal indigestion causes 
attacks of hives and the treatment of this con- 
dition in a previous chapter should be studied. 
To allay the itching apply externally a solu- 
tion of bi-carbonate of soda, two teaspoonfuls to 
the pint of water. This should be patted on 
over the eruption by pieces of cloth saturated 
and left on the itching spots. A bi-carbonate of 
soda tub-bath is beneficial, allowing the water 
to evaporate on the skin. Put two or three 
tablespoonfuls of baking soda in the bath. Men- 
thol will also stop the itching; apply white 
vaseline in which your druggist has put ten 
grains of menthol to each ounce. 

MINOR SKIN TROUBLES 

Prickly Heat. — This condition is overcome by 
seeing that the clothing is sufficiently light for 
the season and is non-irritating. If wool under- 
clothing is the cause change to cotton if the 
weather permits. Keep the child cool, give a 
light diet and a laxative dose of milk of mag- 
nesia. Relieve the itching by dabbing on the 
inflamed blisters or red papules a solution of 
baking-soda and water, a teaspoonful to the pint. 

Insect Bites. — If the sting of the insect is 
left in the wound, pull it out with tweezers. 



256 DISEASES OF INFANCY 

Apply spirits of camphor, ammonia water or a 
solution of baking soda as described above. 

Itch. — This is not common where cleanly 
habits prevail, although it is a contagion that 
may be spread to the careful family from some 
outside source. A minute insect burrows under 
the surface of the skin and deposits its eggs. 
The intense itching and the scattered pimples 
usually appear between the fingers or toes, under 
the arms or about the buttocks, but may come on 
any part of the body. Sometimes the irregular 
lines of ridges where the female insect lays her 
eggs are seen. The irritation is intense and 
the treatment which is strenuous should be under- 
taken by the physician. Sulphur ointment is the 
best remedy we have for itch or scabies. Itch is 
very contagious and all clothing or bed-clothing 
must be carefully disinfected. 

Animal Bites. — The physician should be sent 
for and the wound cauterized. Squeeze the 
wound out thoroughly under warm water, letting 
the blood run out freely, then paint the wound 
or freely pour in tincture of iodine. 

Burns and Scalds. — Pour on sweet oil or olive 
oil or unsalted lard, cover with flour or starch 
to keep out the air. Send for linseed oil and 
limewater, known as caron oil, soak lint in this 
and keep the burns well covered with a bandage. 
Change every day. Open blisters with a needle 
sterilized by holding over a flame. Burns from 



THE SKIN AND NERVOUS SYSTEM 257 

acids should be washed at once with a teaspoon- 
ful of baking soda dissolved in a glass of warm 
water, then treated like other burns. 

Poison Ivy. — The plant has shining, dark- 
green leaves in clusters of three with edges 
slightly irregular. It is found climbing over 
trees, stumps and fences, or bunched together 
in a bushy mass when it is not climbing (then 
called poison oak by some). The Virginia 
creeper resembles it but has five leaves instead 
of three. The rash comes out in a few hours 
after exposure; the skin swells, is hot, red and 
itching. The face may be badly swollen, the 
eyes scarcely opening. The rash discharges 
watery matter and dries in crusts, the process 
lasting a week or more. Cloths wet with boric 
acid solution should be applied and kept changed. 
If the itching is intense the sulphur bath is the 
best relief. Use one-half pound of crude sul- 
phur to a bath-tub of water at 100° F., or slightly 
over the body temperature. Give the sulphur 
bath morning and evening for five minutes. 

Sunburn. — This needs no treatment unless the 
skin becomes tender, blistered and swollen; then 
the injured parts may be covered with zinc- 
oxide ointment. Protection can be afforded to 
the skin not accustomed to exposure by any of 
the good skin lotions or a little plain olive oil 
or cow's cream. 

Freckles. — Don't avoid the sun but shield the 



258 DISEASES OF INFANCY 

face by a broad-brim hat. Many freckle lotions 
are too powerfud to be used for children. A 
safe lotion, easily made, consists of one tea- 
spoonful of compound tincture of benzoin and 
one-half teaspoonful of glycerin to three ounces 
of rose-water. 

Freezing. — In case of frost-bite or freezing 
of fingers, toes, ears or nose apply cold water 
and constant gentle friction. Don't rub an ear 
or nose too hard. Then gradually add hot water 
until the cold water reaches the room tempera- 
ture. (Snow or cold cloths can be used in the 
beginning and the child kept away from the 
stove or heat.) If the freezing has been very 
severe, blisters form over the skin and should 
be annointed with zinc-ozide ointment. In cases 
of extreme exposure where the whole body is 
affected, the child should be kept in a cool room 
for some hours and rubbed with cold water, snow, 
or wrapped in cold wet cloths. Fifteen to thirty 
drops of brandy can be given. When the frozen 
parts have been thawed out they should be well 
covered with ichthyol ointment (twenty-five per 
cent) and the child very cautiously moved to a 
warmer room. Parts that have been frozen are 
often subject to chilblains. 

Chilblains. — These are most apt to develop 
after sudden chilling or warming of the hands 
or feet, such as putting the feet on a hot fender 
after skating; or thrusting thoroughly chilled 



THE SKIN AND NERVOUS SYSTEM 259 

hands in front of a fire. Chilblains cause great 
pain, burning and itching (especially when the 
feet are warm. They are red, smooth, shining 
spots varying in size. If on the feet, blisters and 
ulcers may result from the friction of a tight 
shoe. As chilblains occur more often when the 
circulation is poor, the remedy is to wear woolen 
stockings, mittens or warm gloves (of times an 
abdominal band of wool worn during cold weather 
gives great comfort) and suitably stout shoes. 
Anoint the feet or affected spots with tincture 
of iodine. Improve the circulation by improving 
the general health. 

Boils. — Boils should be opened by a physician 
to allow the pus to escape. Gauze or lint wrung 
out of hot solution of boric acid should be put 
over the boil after it is opened and this fre- 
quently changed. Pus getting on the skin spreads 
the boils to other places. The skin around the 
boil should be covered for a large area with an 
ointment of fifteen per cent boric acid in one 
ounce of vaseline. Never poultice boils. Com- 
pressed yeast taken internally is valuable in 
cases of recurring boils. Use one-fourth cake of 
compressed yeast for children under three; one- 
half cake from three to six years; one cake for 
older children. Take in warm milk or water with 
a little sugar one-half hour before each meal for 
a period of six weeks or more. 

Chapping and Chafing. — Chapping and rough- 



260 DISEASES OF INFANCY 

ening of the skin are prevented by protection 
against cold winds. Dry the skin thoroughly 
after the bath, use pure soap and anoint the 
skin with good olive oil or sterile vaseline, espe- 
cially the hands, cheeks, lips and about the nose 
of little children. Chafing so common in fat 
babies is prevented by using great cleanliness 
in bathing, employing pure soap, carefully wash- 
ing all creases and drying well, dusting in a 
good talc powder and never allowing wet diapers 
to remain on the child. Where the stools are 
loose, cleanse the parts well after each change. 
To red, inflamed areas, if they appear, apply 
zinc-oxide ointment in which your druggist puts 
ten per cent white wax. Lay over this pieces of 
lint or soft linen, and put on thoroughly sun- 
dried diapers. 

Stomach-rash. — This is caused by indigestion 
and the treatment is to regulate the diet to stop 
the indigestion. 

Ringworm. — On the face and body ringworm 
appears in small circular spots of pale-red 
and enlarge into a patch with a deeper red, 
somewhat scaly, edge. On the scalp it comes 
with the same circular patches but more numer- 
ous and with little redness. The hair comes 
out, leaving bald scaly spots with short bristle 
hairs which can be easily pulled out. Ringworm 
is very contagious. The child should not be sent 
to school and should use its own brush, comb, 






THE SKIN AND NERVOUS SYSTEM 261 

towel and other articles and wear a cap to pre- 
vent the germs from flying about. It is caused 
by a minute, mould-like fungus growth. 

Ringworm of the scalp is so difficult to treat 
and control that the physician should be consulted 
at its first appearance. 

Ringworm of the body is easier to manage 
but should be seen by your physician who will 
probably prescribe an ointment to be used on 
the spots twice a day. This consists of one-half 
dram of sulphur, one dram of tar ointment and 
one ounce of benzoated lard. Painting with 
iodine two or three times daily may be 
resorted to. 

Dandruff. — Dandruff and milk-crust in babies 
form yellowish crust-like patches. It should 
be prevented by the cleansing shampoo with pure 
soap and thorough rinsing and drying of the scalp 
and hair. The first patch should be removed 
at once by soaking in warm, olive oil, and wash- 
ing with pure soap and water. Never comb over 
such a patch. When a raw, moist surface 
appears beneath the crust the eruption is eczema 
and the treatment will be found under that head- 
ing. If the scalp is dry it should be frequently 
massaged with yellow vaseline, rubbing it well 
into the roots, and washing with tar soap rubbing 
the lather soundly into the scalp, rinsed in plenty 
of warm and then cold water and well dried. 



262 DISEASES OF INFANCY 

Do this three times a week for two or three 
weeks; then once a week. 

Birth-marks. — Treatment can only be pre- 
scribed by a physician. Some birth-marks can 
be removed, others cannot. They are not caused 
by pre-natal impressions made upon the mind 
of the mother. 

Warts. — Warts often disappear as quickly as 
they come without any treatment. They should 
be let alone, or properly cauterized by a phy- 
sician. 

Nose-bleed. — Some children have frequent 
nose-bleed with no apparent reason, others only 
when falling or striking the nose. Indigestion, 
irritation from fevers, diseases of the heart, 
liver and blood are all causes. Have the child 
sit down with the head held back, the chin up. 
Place cloths wrung out of ice-cold water, or 
with a piece of ice wrapped in it, over the bridge 
of the nose and at the back of the neck. Press 
firmly over the upper lips at the angles of the 
nostrils. Do not blow the nose till the bleeding 
stops. After the bleeding has subsided the 
clotted blood in the nose can be gently sprayed 
out, using the atomizer with any antiseptic solu- 
tion or with warm normal salt solution of one 
teaspoonful of salt to a glass of water. Little 
growths in the nose might be responsible for 
repeated nose-bleed and a physician should be 
consulted in such cases. 



THE SKIN AND NERVOUS SYSTEM 263 

POISONS 

If the following antidotes and treatment for 
the various poisons a child may swallow are 
given promptly they will in nearly all cases be 
successful. 

POISON ANTIDOTE 

Acid (carbolic) Big dose of Epsom salts fol- 
lowed by one-half glass of water in 
which is dissolved one teaspoonful of 
baking soda. 

Acid (oxalic) Cause child to vomit by giving 
mustard and water. After vomiting, 
give big doses of milk of magnesia. 
Follow with glass of milk containing 
two teaspoonfuls of lime water. 

Acid (acetic, hydrochloric, sulphuric, nitric) 
Give large dose of milk of magnesia, 
or baking soda as for carbolic acid. 
Follow by half cup of olive or sweet 
oil. Then give glass of milk with lime 
water. 

Acid (prussic) Get child into fresh air, throw 
cold water on spine and head, inhale 
ammonia, keep up the breathing by 
artificial respiration. 

Aconite Emetic of mustard and water. After 
vomiting give dose of digitalis imme- 
diately, if this is not on hand give 
strong coffee and brandy. JLower the 
head and elevate the feet. 



264 DISEASES OF INFANCY 

Alkalies (ammonia, lye, caustic potash, harts- 
horn) Have child drink a half cup of 
vinegar or a cup of lemon juice. Fol- 
low this with one-half cup of olive or 
sweet oil or melted butter; then a 
drink of milk without the lime water. 

Arsenic (Paris green, "Rough, on Rats") Emetic 
of mustard and warm water. Then 
give big dose of milk of magnesia or 
baking soda and water as for carbolic 
acid. Whites of two eggs beaten in 
glass of milk, then castor oil to empty 
bowels if the milk of magnesia has not 
been given. 

Chloral Emetic of mustard and water to try 
to produce vomiting which is some- 
times difficult. If vomiting does not 
come on at once give two cups of very 
strong coffee ; stimulate the heart with 
strichnine; put hot-water bags and 
warm blankets on the patient. 

Chloroform If too much anesthetic is given and 
the child stops breathing, dash cold 
water over face, pull out tongue to 
prevent strangling, lower the head 
way down. Produce artificial respira- 
tion as for drowning. 

Copper (blue stone, blue vitrol, verdigris) 
Emetic of mustard and water or ipe- 
cac. After vomiting give white of egg 



I 



THE SKIN AND NERVOUS SYSTEM 265 

either alone or with milk. Follow 
with more milk. Use castor oil to 
open bowels. 

Corrosive sublimate (bichloride of mercury) 
Same as above. 

Gas Get child into the open air. Produce 

artificial respiration. Inhale ammonia. 
Dash cold water on head and face. 

Opium (also laudanum, morphine, paregoric, 
soothing syrups, etc.) Try to get 
child to vomit by giving emetic of 
mustard and water. If child does not 
vomit immediately give strong coffee. 
Keep the child awake and walking. 
Strychnine, if on hand, should be 
given with the strong coffee. 

Phosphorus (match heads, roach or rat poisons 
containing phosphorus) Emetic of 
mustard and water. After vomiting 
give dose of peroxide of hydrogen, two 
teaspoonfuls in one-half glass of water. 
Give big dose of Epsom salts to open 
bowels. Do not give milk or oil. 

Poisonous plants (mushrooms) Emetic, and 
after vomiting, strong coffee and 
brandy. The physician will give atro- 
pine as soon as he comes. Keep child 
warm with hot-water bottles and 
blankets and produce artificial respira- 
tion. 



266 DISEASES OF INFANCY 

Spoiled food Emetic to get up all food taken. 
After vomiting give castor oil to clean 
bowels. 

CONVULSIONS AND EPILEPSY 

Convulsions are not uncommon in children, 
especially in the very young. In many of the 
acute infectious diseases of childhood, such as 
diphtheria, scarlet fever, and commonly pneu- 
monia, convulsions are the first symptoms. Acute 
indigestion from an overloaded stomach, the 
irritation of the intestines by worms; in rare 
instances, teething in delicate children; and a 
long adhered foreskin are other causes. A blow 
on the head from a fall may cause convulsions. 
After such an injury if a child has a convulsion 
or bleeding from the nose or ears the head should 
be carefully examined by a physician for any 
possible fracture of the skull. Children who go 
in swimming on a full stomach are apt to have 
convulsions. 

A convulsion may be very slight, lasting only 
a second or two, with slight twitchings of the 
muscles and momentary staring of the eyes. Or 
it may be severe, with fixed eyes, unconscious- 
ness, frothing at the mouth, twitching muscles 
and jerking of the legs and arms. 

Until the physician arrives, get the child at 
once into a hot bath of 100° or 102° F. Put two 
or three tablespoonfuls of mustard in the water. 



THE SKIN AND NERVOUS SYSTEM 267 

If the hot bath cannot be had quickly put the 
feet \n hot mustard water. Then put the child 
to bed, wrapping him warmly. As soon as the 
convulsion is over give a soap-suds enema to 
clean out the bowels, and as soon as the child 
can swallow give a good sized dose of castor oil 
or milk of magnesia. If another convulsion 
follows put the child again in the hot bath or 
hot mustard bath. When your physician arrives 
he may find it necessary to resort to more strenu- 
ous treatment, even to the giving of a few whiffs 
of chloroform. Keep the child in bed and watch 
the temperature; take it three times a day. The 
convulsion may be a first sign of one of the acute 
infectious diseases. Because of this fact, if the 
fever keeps up notify your physician so that 
proper treatment may commence. 

When convulsions are steadily repeated over 
weeks and months of regular or irregular inter- 
vals a most careful study must be made of every 
condition of the child's general health because 
this may lead to epilepsy. All possible irritation 
from enlarged or infected tonsils or adenoids, 
defective teeth, eye-strain or adherent foreskin 
must be removed. All the general instructions 
regarding diet, rest, exercise and environment 
as laid down in the second chapter must be care- 
fully followed. 

Your physician will no doubt prescribe appro- 
priate doses of sodium bromide to diminish the 



268 DISEASES, OP INFANCY 

attacks if he becomes convinced that the attacks 
are true epilepsy. 

There are colonies in this country where epi- 
leptics live a comfortable and useful life under 
ideal surroundings, the whole object being to keep 
the patient out-of-doors, pleasantly and profit- 
ably occupied with no excitement or fatigue, thus 
reducing the attacks. 

ST. VITUS ' DANCE 

Chorea 

This affliction in children is a disease, occur- 
ring between the fourth and sixteenth years as 
a rule, in which involuntary twitchings of the 
muscles may involve a hand, an arm or the entire 
body. An attack of St. Vitus' dance first mani- 
fests itself by awkwardness in using the hands 
or feet, such as stumbling and letting knives, 
forks and cups slip out of the hand. The muscles 
of the hand in a short time begin to twitch, and 
this may extend to the arm, or to both arms; or 
the muscles of the face may. be affected first. 
The twitching and jerking may be so severe as 
to confine the child to bed and he may not even 
be able to feed himself. 

It is pretty generally believed that most St. 
Vitus' dance occurs in children who suffer from 
some form of rheumatism, and the physician 
always looks for evidence of this by an exam- 



THE SKIN AND NERVOUS SYSTEM 269 

ination of the heart. A child can be a victim of 
rheumatism and not have any swellings of the 
joints, the first sign being inflammation of the 
lining of the heart with murmurs and rapid pulse, 
as discussed in detail in the chapter on rheuma- 
tism. In most cases this begins with some infec- 
tion of the tonsils or with an infection around 
the teeth. 

The nervous, anemic, over-tired, run-down 
child, the one who is constantly burning up too 
much of his limited energy, is often the victim 
of St. Vitus' dance. 

The Treatment. — The first step is rest, as near 
complete rest as possible. If the twitching is 
mild or if putting to bed makes the child unhappy 
or restless it is not necessary. In severe cases 
rest in bed for three to four weeks is essential, 
preferably on a sleeping porch or in the open 
air. The principal thing is to keep the child 
quiet and away from all nervous, fussy or irrita- 
ble people. The one who takes charge of the 
child should have a resting influence. Oftimes 
the mother has become so filled with anxiety 
for the child that it is better to send for a nurse 
or relative ; someone who can keep the mind 
pleasantly diverted by reading and games which 
do not tire, mentally or physically, and by pleas- 
ant talk. School or hard play must not be 
thought of , no matter how mild the attack. Quiet 
outdoor diversion can be had but always under 



270 DISEASES OF INFANCY 

the guidance of someone who keeps the child 
from getting overtired or excited. 

Your physician will prescribe the same inter- 
nal treatment as for rheumatism. Sodium sali- 
cylate (four or five grains for the child over five 
years) should be given immediately after each 
meal ; two hours after meals give an equal amount 
of bi-carbonate of soda. All children suffering 
from St. Vitus' dance should be given Fowler's 
solution under the physician's direction, begin- 
ning with very small doses which are cautiously 
increased, if they do not upset the digestion, up 
to seven or eight drops three times a day after 
meals, in a half -glass of water. 

The diet at first should be of well-cooked 
cereals and vegetables, fruit juices and stewed 
fruits, milk and preferably buttermilk if the 
child will take it, bread and butter, the whites 
of eggs, and cheese for children over six. As 
the child improves, poultry or red meat can be 
given three times a week. When the twitchings 
cease resume the regular diet, including meat 
once a day. Poultry and fish are meat and 
must not be given on the same day with other 
meat. It may take some weeks or months for 
the child to recover; patience is necessary and 
care must be exercised for a long period after 
the twitchings have disappeared so a thorough 
cure may be effected with no return of the 
condition. 



i 



CHAPTER XXIV 
RHEUMATISM IN CHILDREN 

Rheumatism in children often goes unrecog- 
nized, its existence not even being thought of, 
until it has produced untold injury to the heart. 
And when rheumatism in children is neglected, 
or improperly treated, in most instances it 
results in chronic invalidism. 

The heart receives the brunt of the attack, and 
may be left with scars that never heal and so 
weakened that it easily breaks down under slight 
added strain. Mothers should use every means 
to safeguard their children against rheumatism. 

The symptoms are difficult to recognize in 
some children because they come on so grad- 
ually. One of the first signs the mother should 
be suspicious of is a great deal of lassitude; or 
perhaps the child will complain only of fatigue 
after slight exertion. The fatigue is usually, 
however, accompanied by indistinct pains, so 
often called "growing pains.' ' 

Rheumatism in some children starts abruptly 
with high fever, sore throat and more or less 

271 



272 DISEASES OF INFANCY 

pain in the joints. The joint pains in most cases 
are not severe. 

There are three distinct peculiarities of rheu- 
matic fever in children: First, a comparatively 
mild inflammation of the joints. Second, an 
involvement of the heart, which may be the first 
and only symptom. Third, its tendency to recur, 
each succeeding attack adding a greater injury 
to the heart. 

Rheumatism in childhood is always an infec- 
tion and it' resembles tuberculosis in this respect : 
once the body is infected it may be difficult to 
tell when the infection is entirely overcome. The 
lungs, when gravely damaged by tuberculosis, 
probably never recover their entire efficiency; 
permanent scars are left. This is true of the 
heart when acute rheumatism attacks the child. 
Much chronic heart trouble ip. adult life is the 
result of irreparable scars left by attacks of 
rheumatism in childhood. 

Rheumatism before the fourth year is rare, but 
from this time on the percentage of cases rapidly 
increases, being greatest between the ninth and 
twentieth years. Rheumatism was regarded until 
recent years as primarily a danger to the joints. 
We know now that in children it is primarily a 
danger to the heart. 

Uric acid is not responsible for rheumatism in 
children as is often supposed, nor have we any 
evidence to support the theory that meat is either 



RHEUMATISM IN CHILDREN 273 

highly injurious or the direct cause of acute rheu- 
matism. Indeed, we find rheumatism prevalent 
among classes where the meat diet is more or 
less restricted, and often so insufficient as to 
result in a lowered vitality. We know that as 
soon as a child's vitality is lowered he easily 
becomes a prey to infections. I strongly urge 
that when a child suffers from acute rheumatism, 
if his digestion permits, that after the acute 
attack he be given a liberal, general diet with 
an allowance of fresh meat, such as roast beef, 
steak or mutton, once a day. 

This infection gets into the child's system in 
various ways. Eheumatism frequently follows 
an attack of scarlet fever, which is directly due 
to infection. If you will carefully observe many 
cases of rheumatism in children, you will find in 
nearly all of them in the beginning, sore throat. 
There is no denying that diseased and unhealthy 
tonsils are responsible for admitting the infection 
to the system. A tonsil does not have to be large 
or painful to cause rheumatism, nor is there any 
peculiar form of tonsillitis more liable to cause 
it, but we repeatedly find children who are sub- 
ject to tonsillitis, sooner or later developing defi- 
nite signs of rheumatism. 

In such cases there is one thing to do; remove 
the tonsils. Painting them over or attacking 
them with gargles may be of some slight service 
but this treatment does not remove the deep 



274 DISEASES OF INFANCY 

pockets of pus so often found. And when the 
tonsil is removed it must be completely removed. 
Simply clipping off part is a useless operation. 
You may have had advice against removing a 
child's tonsils, but there is nothing in actual expe- 
rience to support such advice when the tonsils 
are unhealthy or infected. 

Chronic infection is carried into the mouths 
of many thousands of children through decayed 
or infected teeth, and decayed teeth can keep not 
only the mouth but the throat and the entire sys- 
tem in a constantly poisoned state. There cannot 
be the slightest doubt that many cases of rheu- 
matism are directly traceable to bad teeth. 
Therefore, it is most important that the child 
suffering from rheumatism pay strict attention 
to oral hygiene. . His mouth and teeth should be 
attended to regularly and any evidences of infec- 
tion removed. 

In one of the largest hospitals in London each 
mother who brings her child for treatment is 
given a card bearing the following valuable 
suggestions : 

1st. The great danger of rheumatism 
in childhood is the damage it does to the 
heart and not to the joints. 

2nd. Acute rheumatism or rheumatic 
fever is a disease which often starts 
without severe illness, but with pains in 






RHEUMATISM IN CHILDREN 275 

the limbs, frequently termed growing 
pains, or with a stiff neck. 

3rd. Children whose hearts are 
attacked by rheumatism need not have 
severe pains in the heart as symptoms. 
Slight breathlessness or palpitation may 
be their only symptoms. 

4th. A child with rheumatism should 
always have his heart examined by the 
doctor. 

5th. Rheumatism runs strongly in 
families. 

6th. A sore throat may prove the 
commencement of an attack of 
rheumatism. 

7th. St. Vitus' dance is generally 
nothing but a form of rheumatism. 
Nervousness, dropping things, headache 
and jerky movements are often the real 
signs of this illness. 

8th. Rheumatic children need warm 
clothing and good boots. The extrem- 
ities should always be protected. 

9th. Damp houses and rooms, wet 
clothes and damp neighborhoods, are 
particularly injurious to the rheumatic. 

10th. Children with rheumatic heart 
disease need a long time to get well in», 
because the heart is softened by the dis- 
ease, and it must get strong again before 



276 DISEASES OF INFANCY 

the child can run about in the usual 
manner. 

11th. Rheumatism often attacks chil- 
dren more than once. Late autumn and 
early spring are the times of real 
danger. 

These suggestions are of great practical value. 
Most mothers need only simple guidance in tak- 
ing steps, no matter how limited their means, to 
defend their children from exposure and attack. 

"We must not lose sight of the importance of 
taking time to recover from attacks of rheumatic 
heart-disease. A child must not be rushed out 
of bed or out of the hospital and allowed to take 
up his usual routine of exercise, for the sudden 
strain will again break down the weakened heart. 
Never allow a rheumatic child to exercise vio- 
lently. Teachers should so acquaint themselves 
with the nature of acute rheumatism as to aid in 
every possible way the recovery of an unfortu- 
nate child, never imposing tasks 'that strain. 

St. Vitus' dance commonly has its origin in 
rheumatism. And it is true that children of 
rheumatic parents show a tendency to acquire the 
disease. We do not know why this is unless the 
child has inherited a poor resistance against cer^ 
tain forms of infection. 

Rheumatism has prevalence in large cities, 
when with a long spell of dry weather dust begins 



RHEUMATISM IN CHILDREN 277 

to cause throat infections. The abrupt and diffi- 
cult changes of climate make the people of many 
sections of this country subject to the disease. 
This danger from dampness and sudden cold 
must be thwarted by special care to improve the 
general health of the child. 

ARTHRITIS 

Until now we have been speaking of the common 
acute rheumatism caused by the poisons thrown 
off by the bacteria of rheumatism absorbed 
into the blood and carried to joints, muscles, 
heart and other parts. But it happens in many 
cases that these germs are so virulent, and the 
child's resistance to them so low that the actual 
germs themselves, instead of their poisons, gain 
entrance to the blood, and are carried directly to 
some joint. The moment they reach the joint, 
they set up so violent an inflammation that the 
delicate membrane covering the surface of the 
joint is destroyed, and hard connective tissue 
forms in its place. This hard tissue acts to 
destroy the smooth working of the joint surface 
and results in leaving a stiff, immovable and use- 
less joint for life. Many times these joints are 
left seriously deformed from being constantly 
drawn up in pain. 

The Treatment of Arthritis. — It is tremen- 
dously important to know when this severe and 
dangerous form of infection has entered the sys- 



278 DISEASES OF INFANCY 

tern and what steps to take to prevent permanent 
crippling of some joint. 

In the first place, when this infection enters 
the system it always follows a few days after 
some sharp infection elsewhere in the body — an 
acutely sort throat, an abscessed tooth, an attack 
of tonsillitis. It takes a few days for the bacteria 
to make the trip through the blood to the joint 
attacked, but the moment these bacteria reach 
the joint two characteristic symptoms develop 
which will be your guides. 

There will be first a chill, sometimes slight, 
sometimes severe, but always a chill. And fol- 
lowing this will be a sharp rise of temperature 
showing fever; then a sudden, severe pain in the 
affected joint; not several joints, but just one. 
The joint will become swollen, red and painful, 
and any attempt to move it will not only be very 
harmful to the joint itself but excruciatingly 
painful. 

Send for your physician at once, put the child 
to bed, and keep the joint completely and obso- 
lutely at rest. Your physician will put a weight 
at the end of the arm or leg strong enough and 
secure enough to slightly separate the bones of 
the infected joint and keep them from pressing 
against each other. This relieves the pressure in 
the joint caused by the swelling and inflammation 
and protects the delicate membrane covering both 
ends of the inflamed bones of the joint from being 



RHEUMATISM IN CHILDREN 279 

destroyed. When this is faithfully done until all 
the inflammation and fever have disappeared, the 
joint will not be left stiff, useless and crippled. 

THE GENERAL TREATMENT 

The time to treat rheumatism in children is at 
the first signs of its presence, or at the first sus- 
picion of a tendency to it. There are a number 
of early symptoms which the mother should rec- 
ognize and heed unfailingly. 

When your child complains from day to day 
of being tired ; when he says over and over again, 
"my leg hurts" or speaks of pains in his arms 
or thigh ; when he looks pale and is easily tired 
after a little exertion, and breathless after ordi- 
nary running or going up and down stairs ; when 
he has continued sore throat or several attacks 
of tonsillitis ; these signs are the warning that 
the infection has gotten into the system. Should 
I come to your home as your physician and learn 
of these signs from you, I would be guilty of 
gross negligence if I did not at once make an 
examination of the child's heart. And when I 
had listened to its beat and found signs of irregu- 
larities, or murmurs or any symptoms showing 
that the heart was affected, unless I directed that 
the tonsils should be removed if infected and 
I mean taken out entirely — clean, not partially 
removed — the teeth attended to and the child 
put to bed until the heart-beat had returned to 



280 DISEASES OP INFANCY 

normal, I should be guilty of condemning your 
little son or daughter to long years of invalidism 

Making the mouth and throat safe is the first 
essential measure. Best in bed and quiet are 
the next steps. The child should be kept in a 
recumbent position and not allowed to make any 
exertion. To secure mental rest, visitors should 
be excluded, old toys used and old stories told 
to avoid all excitement. 

Sodium salicylate and sodium bicarbonate 
should be given after each meal and at bed- 
time, preferably in a half glass of milk. The 
dose for children from two to four years is three 
grains of sodium salicylate and three grains of 
sodium bicarbonate; from four to six years, . 
five grains of each; for older children, seven 
grains of each. In case this upsets the stomach 
give double this dosage by the rectum, dissolved 
in one tablespoonful of thj.n starch water. Con- 
tinue until all signs of rheumatism have 
disappeared. 

During the acute period the child should receive 
only semi-liquid foods because there is almost 
always some fever. Give no meats or meat 
broths; but gruels, milk, buttermilk, milk-toast, 
junket and the white of egg stirred in milk. Solid 
foods must be stopped until the temperature has 
disappeared. Then give perfectly fresh eggs, 
well-cooked vegetables and thoroughly well-done 
beef or mutton, at first two and then three times 



RHEUMATISM IN CHILDREN 281 

a week. Meat should be broiled or roasted, never 
fried. On the days when meat is omitted give 
meat broth, or beef juice. 

During the first few days of the acute illness, 
give milk diluted with one-third Vichy or Lithia 
water (plain water if necessary) alternated with 
gruels. 

The direct treatment for the inflammation in 
the joints is the next important step to consider. 
Hot applications to the joints give the most 
relief. First, rub gently on the afflicted part oil 
of wintergreen, then apply hot flannel which has 
been heated in an oven. Dry heat is better than 
hot water heat. Another relief for the pain is to 
put into a quart or more of hot water as much 
Epsom salts as the water will dissolve and wring 
out of this linen or cotton cloths and lay over 
the aching joints, as hot as can be borne, renew- 
ing it before it cools. In many cases this will give 
entire relief in a very few hours. Several joints 
can be treated at the same time. Another meas- 
ure is the use of lead and opium wash, which you 
can procure from your druggist, and apply hot 
on lint or cotton cloth. Those who have elec- 
tricity can use the heat from two or three lights 
in a strong reflector. This dry heat applied over 
the joints is very grateful. Some one of these 
measures must be kept up until the pain has been 
entirely relieved. 

The one thing the physician watches guardedly 



282 DISEASES OF INFANCY 

from the beginning is the heart. He warns the 
mother about the child's rest so that all strain 
be taken from the little heart; about the diet so 
that gas does not form and press against the 
heart ; about the bowels, so that all poisons be car- 
ried out of the system. The warm bath helps this 
elimination, and it can be given in bed. The child 
may be given hot packs in bed to produce profuse 
sweating, but this must be done on the physi- 
cian's advice as it may be too severe for the heart 
if badly affected. If the child has considerable 
fever the cool sponge in bed two or three times 
a day is advisable. The warm enema is essential 
in keeping the bowels thoroughly flushed. Put 
a teaspoonful of bicarbonate of soda, or baking 
soda in each pint of water, give this very warm, 
let the child lie on his side and retain all of it 
that is possible, a pint or two. This is a stimu- 
lant to the action of the kidneys and helps elimi- 
nate the poisons. Drinking water should be taken 
in abundance. 

AFTER AN ATTACK OF RHEUMATISM 

When your child has recovered from an attack 
of rheumatism use all the precautions to prevent 
its recurrence. Each subsequent attack leaves 
the heart weaker. 

See to it that your child does not play in a 
damp place, that the room where he sleeps is well 
aired day and night, that his clothing is warm 



RHEUMATISM IN CHILDREN 283 

with wool garments next the skin in the danger- 
ous seasons of the year. Keep the feet dry. If 
the child has had a severe attack let him spend 
the winter in a warm, dry climate where recovery 
can be complete. Limit the work and play and 
close application to books, don't allow hard run- 
ning or lifting. Have the teeth examined regularly 
every six months or oftener by a competent 
dentist. Build up the general health ; rheumatism 
leaves children very anemic. They need some 
form of iron, such as Blaud's Pills, after meals 
for children seven years old and over, or some 
other tonic of iron that your physician can pre- 
scribe for the individual child. Cod liver oil can 
be given at any age and is excellent for rheumatic 
children. 



CHAPTER XXV 
HEART DISEASE IN CHILDREN 

Heart disease is more often overlooked than 
any other illness of childhood and this oversight 
leads to disastrous results, often lasting for a 
lifetime. All the infectious diseases that children 
are subject to, as we have pointed out in their 
respective chapters, may leave their imprint more 
or less deep and lasting, as the case may be, on 
the heart. I can think of no better excuse to 
offer for the parent who has paid no particular 
attention to the heart of the child than the old 
adage, "out of sight, out of mind." Heart dis- 
ease in adult life is often unnecessarily due solely 
to an overlooked slightly weakened or overtaxed 
heart in the child who has had scarlet fever, la 
grippe, whooping cough, pneumonia or diph- 
theria, or who has been subject to repeated 
attacks of bronchitis and other weakening ill- 
nesses, especially tonsillitis and rheumatism. 

The heart is a strong muscle but it works 
unceasingly and in the child who is not robust 
or constitutionally rugged, who is not up to 
weight for his age and height, it is daily sub- 

284 



HEART DISEASE IN CHILDREN 285 

mitted to too great a strain if that child is 
allowed the same freedom of running, jumping, 
lifting and playing about as his stronger play- 
mates. 

The heart is a muscular bag about the size of 
the closed fist, weighing from eight to twelve 
ounces and increasing in size yearly up to middle 
life. A strong partition divides it into the right 
and left sides and each side is again divided into 
two, making four chambers, between which are 
openings guarded by strong valves which open 
and close as the blood is forced through. The 
entire interior of the heart is lined with a deli- 
cate shining membrane, the endocardium. The 
heart muscle itself with the four chambers is 
called the myocardium and this is surrounded by 
a strong fibrous bag known as the pericardium, 
lubricated on its interior surface so that the great 
heart-muscle works smoothly and easily without 
friction. 

Beginning with heart disease in the infant we 
have the condition that exists in what we term, 
"the blue baby." This is a deformity of the 
heart that is congenital and no pre-natal influence 
is responsible for this unfortunate condition. 
Rarely do these babies survive the first year, a 
few reach the run-about age, but when the 
added strain of the child's being about on its 
feet is put on the heart, the muscle is quickly 
exhausted. In explaining this condition, let me 



286 DISEASES OF INFANCY 

remind you that the veins carry the dark blood, 
which is dark because it is full of waste and pois- 
onous matter which must be gotten rid of, and 
this is collected and carried to the right side of 
the heart. From there it is pumped into the 
lungs to the multitudinous tiny air cells where 
it unloads the poison and waste in the form of 
carbon dioxid gas and takes up the oxygen in 
the air that is breathed into the lungs. The 
moment the oxygen combines with the blood, the 
blood ceases to be dark bluish red and becomes 
a bright red, known as arterial red. This bright 
blood is taken back to the left side of the heart 
and from there distributed to every part of the 
body. The right and left sides of the heart are 
separated from each other by a strong partition 
in which there is no opening in the normal baby. 
In the case of the "blue baby" this partition is 
not completely closed, and some of the dark 
impure blood flows through into the bright pure 
blood before it has been taken to the lungs for 
purifying and to receive oxygen, and the venous 
blood is circulated back into the system. Occa- 
sionally a child with this condition will live to 
be ten or twelve years old, but such length of 
life is exceptional. 

In any of the diseases of childhood, when the 
poisons of the disease are circulating in the blood 
as they pass through the heart, both in the venous 
blood flowing through the right side and in the 



HEART DISEASE IN CHILDREN 237 

red blood flowing through the left side, they may 
attack the delicate lining of the heart and set up 
an inflammation. Inflammation here as elsewhere 
may leave scars and when these scars occur on 
the valves between the chambers of the heart it 
shrinks them so that they do not close completely. 
When the heart is functioning correctly, blood 
flows into the upper chamber of the heart and 
when that is filled, the blood is passed into the 
lower chamber through the valve which closes 
after it. When the lower chamber is filled with 
blood it is pumped out and the valve between 
the chambers opens, admitting the blood from the 
upper chamber again and so on. When the valves 
do not close completely, we have the condition of 
"leaky valves, " — the blood is constantly leaking 
back. The muscles of the heart make an effort 
to accommodate themselves to this extra work 
of pumping back the blood that is constantly 
leaking back and get larger with the extra exercise. 
With care and favorable circumstances this con- 
♦ dition may not result disastrously. But if the 
poisons of disease again and again attack the 
lining of the heart, if there is too much strain 
put on the heart by overwork or play such as run- 
ning and jumping strenuously, the muscles may 
become weak and begin to stretch; more and 
more blood leaking back. The heart then dilates, 
and the blood begins to stagnate instead of being 
properly pumped through the chambers as before. 



288 DISEASES OF INFANCY 

The circulation gets weak, limbs and feet swell 
and unless the heart is immediately relieved of 
its work, by the patient being taken off his feet 
entirely and put flat on his back, the termination 
of the condition is fatal. 

Thus we see in the child that has not had suffi- 
cient rest and building-up after illness, and who 
is overtaxing daily by too much play and running 
about, that the heart muscles affected by the 
poisons of the disease, and afterward over- 
exerted, begin to relax and fail to push the blood 
along, the circulation becomes weak and stagnant, 
none of the organs can perform their natural 
functions properly because of this impaired cir- 
culation and the result is a general run-down 
condition. The child easily becomes tired and 
listless, he becomes out of breath with a little 
exertion, and is often wrongly thought to be lazy 
and careless. 

The signs that the heart is affected may appear 
when the child is still in bed, while the disease is 
running its course, or they may come on during • 
convalescence or afterward. The signs are a 
rapid irregular pulse, and sometimes the pulse 
becomes very slow. The child is pale or blue 
about the lips, finger-tips and toes with cold 
hands and feet, breathes rapidly and feels faint. 
When such an attack comes on after the child 
has gotten out of bed after illness he will sud- 
denly become weak and pale after a slight exer- 



HEART DISEASE IN CHILDREN 289 

tion, or be breathless after going upstairs or 
walking rapidly. 

During an acute illness, especially one of the 
acute infectious diseases, the heart may become 
suddenly swamped by poisons and there will 
develop an acute endocarditis. The pulse then 
becomes very rapid and very weak; the child 
may vomit and the fever mount high; the face 
will get extremely pale and pinched with a bluish 
tinge about the lips; and the breath will come 
rapidly. 

When such a condition develops your physician 
must give the case immediate attention because 
it may rapidly prove fatal. He will have to sup- 
port the heart with stimulants. The child must 
be kept very quiet, nor allowed the slightest exer- 
tion in bed. An ice-bag must be put over the 
heart and only a small amount of fluid diet given, 
preferably at two-hour intervals. 

In the heart-disease that comes on more slowly 
and in which the symptoms are not severe there 
is only one treatment which is of any real value, 
and that is complete rest in bed until the heart- 
beats become normal and the pulse strong and 
regular. You can only get accurate information 
about the pulse in a child by taking it while he 
is asleep because any little excitement, especially 
in very young children, will send the pulse up 
and often make it irregular. The normal pulse 
rate in children is given in the following table: 



290 DISEASES OF INFANCY 

PULSE-BATE DTJEING INFANCY AND CHILDHOOD 

At birth 130 to 150 

First year 130 to 120 

Two to four years 110 to 90 

Six to ten years 100 to 90 

Ten to fourteen years 90 to 80 

There is nothing that taxes a mother's inge- 
nuity more than the keeping of the child in bed 
where the heart has been affected because this 
rest in bed may have to be carried out for many 
weeks, even months. 

There must be complete rest and relaxation and 
the child should lie flat on his back. As his pulse 
becomes more normal his head can be raised by 
pillows slowly. If the pulse gets rapid again the 
head should be lowered. The child should be read 
to and kept amused, he can play with toys on 
the bed without raising his head. As the heart 
improves he can be raised to a sitting position, 
then put in a wheeled chair after a few days. 
Careful watch must be kept of the heart and if 
there is a return to the weak or irregular pulse 
he should be put back to bed for a time. This is 
a slow process and an ordeal for the mother as 
it may take six weeks or six months to get the 
heart back into shape, but the child's whole future 
depends upon it. 

Children have great recuperative powers, the 
heart muscle can accomplish wonders if rest is 



HEART DISEASE IN CHILDREN 291 

given and continued. If the child whose 
heart is affected fails to receive the proper treat- 
ment he will probably always be sickly and weak, 
a burden to himself and those about him. Don't 
give up until the fight is won. Children with 
badly affected hearts with right care grow up into 
strong men and women. 

Guard your child carefully after any acute, 
infectious disease; watch the heart constantly 
throughout the attack and afterward until the 
child is well and strong. 

The Diet. — Until the pulse has returned to 
normal, the child should be kept on a liquid or 
semi-liquid diet. Instead of three meals give a 
smaller amount of food every two hours. Milk, 
and for younger children the milk should be 
diluted with half water ; gruel ; strained vegetable 
soup and mutton and chicken broth can safely 
be given. The child under three should have milk 
and gruels with a small amount of zwiebach. 
When the pulse is normal and the child is able to 
sit up in bed, give soft egg, custards, milk-toast, 
junket, a little finely cut lamb or chicken, adding 
these gradually to the diet and. changing to three 
meals a day. The reason for the small amount 
of food at short intervals at first is to prevent 
distending the stomach and the formation of gas 
which would press up against the diaphram 
interfering with the action of the heart. Keep 
the bowels open daily, using a sufficient amount 



292 DISEASES OF INFANCY 

of milk of magnesia, or small amounts of citrate 
of magnesia or rhubarb and soda, to cause one 
good evacuation daily. 

Bathing. — While in bed the child should 
receive the daily warm sponge bath for cleans- 
ing; a teaspoonful of salt added makes this very 
refreshing. Gentle massage of the body after 
the bath with olive oil is very helpful to the cir- 
culation and will help to keep up the nourishment. 
As soon as the heart is strong enough give the 
daily warm brine tub-bath described in the first 
chapter. 

The air in the sick-room must be kept fresh at 
all times and as soon as the child is able to be 
carried out on the porch, place him on a cot in 
the open air, with sufficient covering if the 
weather is cool, and if possible use a sleeping 
porch at any time during the year. Follow the 
rules on convalescence laid down in the first 
chapter. 

Finally, as a word of caution, let me say that 
very often a child is suffering from a damaged 
heart, the lining may have become inflammed, 
there may be a murmur with a " leaky" valve, 
all calling for the treatment I have just pre- 
scribed; and yet because the child has not been 
downright sick, has simply complained of being 
tired, or of pains which were called "growing 
pains,' ' and has just been thin and run-down, 
he does not receive attention until his heart 



HEART DISEASE IN CHILDREN 293 

happens to be examined by the physician who is 
called to attend him in one of the other diseases 
of childhood. 

ANEMIA 

Anemia means an impoverished condition of 
the blood in which the normal number of red cor- 
puscles are diminished and the coloring matter 
of the blood known as the hemoglobin becomes 
reduced. Anemia is quite common in childhood 
and may occur after any illness, especially the 
acute infectious diseases and through errors in 
diet and hygiene. All children who are below 
normal, who suffer from poor nutrition, have 
some degree of anemia which may become very 
pronounced. 

The most apparent symptoms are weakness, 
indifferent appetite, constipation, restless sleep, 
irritability and nervousness. These children are 
not able to keep up with their mates in school or 
play. They tire easily, are thus inclined to be 
unhappy and are usually pale and thin although 
anemia is at times seen in children who are not 
thin, or who do not look pale. 

"When a group of these symptoms is present 
the blood should be examined by the physician 
and if the red corpuscles are found deficient, 
treatment to increase them and build up the blood 
should begin at once. If anemia persists for any 
length of time the system's resistance to all dis- 
ease is lowered. 



294 DISEASES OF INFANCY 

Most important are diet and hygiene, and this 
management is detailed in the chapter on Malnu- 
trition, not only as to the proper food, daily 
habits and environment but as to the beneficial 
tonics of iron and cod-liver oil. 



CHAPTER XXVI 

MALAKIA 

Malaria is commonly known in pome localities 
of the United States as ague, or fever and ague, 
also as marsh fever. Except in distinct malarial 
districts it is not as common in childhood as sup- 
posed. Malaria is carried by a mosquito or gnat 
of the genus Anopheles. This is not the com- 
monest of all mosquitoes which has a hump- 
backed attitude as he sucks the blood. In Ano- 
pheles the proboscis, head and body are in a 
straight line, or inclined at an angle the tail 
sticking out as the mosquito sucks the blood. 
These mosquitoes live in low, marshy places espe- 
cially where there is stagnant water. Malaria is 
caused by a parasite which lives in the blood and 
when the mosquito bites such a victim it takes 
this parasite into the salivary glands of its 
mouth. There it lives and when the mosquito 
bites a healthy person it injects this infection into 
the blood. Thus you see the disease does not 
originate with the mosquito but is carried by the 
mosquito from the sick to the well and is not 
carried in any other way. There are different 

295 



/ 
296 DISEASES OF INFANCY 

types of these malaria parasites in the blood. 
One when it gets into the blood produces the 
chills and fever every second day. Another type 
produces the same symptoms every third day. 
And if the individual is twice infected with the 
same parasite which causes the chills and fever 
every second day, as sometimes happens, the 
chills and fever will come on every day. 

The symptoms start with a chill ; in very young 
children this may be slight; in older children the 
chill is more pronounced, amounting to shivering 
and chattering of the teeth. With the chill comes 
fever which rises very high, 103° to 105° F. The 
chill will pass and the fever continue high, the 
skin being hot and dry and red. This continues 
for a period of a few hours and then the fever 
drops to normal, sometimes below normal. From 
the time the chill starts until the fever disappears 
ten or twelve hours will elapse. After the fever 
has passed the child will feel fairly well but a 
little weak. Then at the same hour on the second 
or on the third day, depending upon the type of 
the infection, the chill will appear again with the 
same symptoms, unless the child happens to have 
a double infection and then the chills and fever 
will come on every day at the same hour. 

When the chill develops, the child becomes 
extremely thirsty, with headache and a feeling of 
great prostration. The sweating, with the drop 
of temperature, usually comes on in the night 



MALARIA 297 

and then the child will fall asleep usually for the 
remainder of the night. 

Many conditions are ascribed to malaria in 
children where malaria does not exist, but where 
the fever resembles it. In cases of indigestion, 
very commonly in tuberculosis, and in infections 
of various parts of the body, such as infection 
of the pelvis of the kidneys, and of the bladder 
and intestines, the fever and chill are often mis- 
taken for malarial fever, even by the physician. 

Whenever there is any question that the dis- 
ease is malaria the presence of the parasite which 
causes malaria should be determined by a micro- 
scopical examination of the blood. This is 
important, else the child may be given large doses 
of quinine in an attempt to remedy a condition 
which is not malarial. 

Treatment. — The principal measure in the 
treatment is prevention. The dwelling near low- 
lying land, especially where there is stagnant 
water should be carefully protected by screens. 
In localities where malaria is known to exist 
children should not be allowed outside of a well- 
screened area after sun-down or before sun- 
rise in the morning. The malaria-carrying type 
of mosquito is always active at these hours 
of the night and flies near the ground. Swamps 
and stagnant water pools in malarial districts 
should be covered with oil to prevent the mos- 
quito from breeding. In the interests 6i sanita- 



298 DISEASES OF INFANCY 

tion all such districts should be drained if 
possible. 

Two drugs are of great value; quinine, and 
arsenic in the form of Fowler's solution. Your 
physician will prescribe the proper dose of qui- 
nine which taken internally rapidly destroys the 
parasite in the blood. The diet during the attack 
of chills and fever should consist of broths, milk 
and thin gruels only. Where the disease has 
existed for any length of time, the parasite causes 
a rapid thinning of the blood resulting in anemia. 
It is then necessary to build up the general health 
and nutrition and condition of the blood accord- 
ing to the directions laid down in the chapter, 
Malnutrition. 



CHAPTER XXVII 
SCURVY 

Scurvy is a disease which mothers very com- 
monly confuse with rickets. It is a distinct con- 
dition, however, which may occur in infants, 
usually after the sixth month and seldom after 
the second year. It may appear in very young 
babies, but this is rare. Scurvy will afflict the 
breast baby and the bottle baby and babies fed 
on all kinds of artificial foods. It can usually 
be traced to some radical error in the food, the 
most common being a one-sided diet, such as a 
cow's milk mixture or manufactured baby food 
too rich in one element and too weak in others. 
Perhaps the most common one-sided food is that 
which is too rich in sugar and very low in fat and 
protein. 

In some instances, scurvy is known to follow 
the use of pasteurized milk and boiled milk where 
the mother has omitted to give orange juice. Pas- 
teurizing or boiling milk does not injure its nutri- 
tional value as a food but it destroys certain sub- 
stances known as ^vitamines." These vitamines 
are very low at times in mother's milk and in 

299 



300 DISEASES OF INFANCY 

raw cow's milk as well, and this has been known 
to cause scurvy. 

The symptoms of scurvy are very typical. 
Decided changes take place in the bones, and the 
ends of the long bones of the legs and arms swell 
directly around the joints. There will be at 
times little areas of bleeding under the skin and 
under the coverings of the bones. The gums will 
bleed easily and at times become greatly swollen. 
So much so in certain cases that the teeth will be 
completely covered. 

Usually the first symptom the mother notices 
is the evidence of pain when the baby's legs or 
arms are moved. The mother will usually notice 
this for the first time when she puts on the dia- 
per. The baby will cry as though in great pain 
when his limbs are moved apart. One strange 
thing about the pain in the limbs is that the 
baby will hold one leg or arm perfectly still and 
move the other limbs freely. There is excruciat- 
ing pain and tenderness so that the baby will 
scream when you simply touch his limbs or even 
jar the bed. The part affected most will be 
sharply swollen about the joints and many times 
this swelling will involve the whole leg or arm* 
and it will become two or three times its natural 
size. 

The baby suffering from scurvy should be 
moved with the greatest care, not only on account 
of the pain but because of the danger of injuring 



SCURVY 301 

the bones. He must not be put into the bath tub 
but gently sponged in bed, and in moving from 
one bed to another the way that has been adopted 
in the baby hospitals is a good one for mothers 
to use. Simply pick the baby up by holding the 
four corners of the sheet. The spine in scurvy 
is often so extremely tender that this is the only 
way in which the baby can be moved without 
causing acute suffering. 

The bones are affected early in the disease; 
even before it is recognized they become brittle 
and can very easily be broken. 

Perhaps the most interesting thing for the 
mother to learn about scurvy is that as soon as 
it is recognized and properly treated, it disap- 
pears within a short time. Babies have repeat- 
edly made complete recoveries in six or seven 
days when they have received the right care 
before the disease became too far advanced. 
Even in the more serious cases of scurvy, babies 
nearly always recover although it takes a little 
longer, sometimes a few months for all signs to 
disappear. 

The use of orange juice will promptly cure 
scurvy. Most babies with scurvy will take orange 
juice with great greediness. The baby six months 
old should receive one teaspoonful every two 
hours. Occasionally, there will be a baby whose 
digestion will be upset by orange juice, and these 
babies should be given beef juice which is used 



302 DISEASES OP INFANCY 

with great success in the treatment of scurvy 
after the sixth month. Begin with one teaspoon- 
ful a day and if the baby takes that successfully, 
increase it to four or five teaspoonfuls within two 
or three months. This should be given just before 
the midday feeding. Always make fresh beef 
juice according to the directions found in the 
volume, The Proper Feeding of Infants. 

In younger babies who should not receive meat 
juice, if orange juice upsets the stomach, other 
fresh fruit juices should be tried. The juice of 
fresh raspberries or peaches is of value but it 
does not rate with orange juice. Orange juice 
contains an essential vitamine which seems to 
be deficient in milk at times. Orange juice should 
always be given to babies fed on pasteurized, 
boiled or condensed milk, and when this is done, 
the mother need have no fear of the development 
of scurvy. 

At the first signs of scurvy, you must always 
carefully look to the baby's food to discover a 
possible error, such as the giving of a one-sided 
food containing too much of one element and not 
enough of the others. Carefully study the formu- 
las you are using to see that the fat, sugar and 
protein are all in the proper proportion. 

Lastly, if you have been giving the baby boiled 
milk) you had better, until the symptoms of 
scurvy disappear, return to the use of raw milk. 
When you go back to the boiled milk, be sure to 



SCURVY 303 



give the baby three or four teaspoonfuls of 
orange juice an hour before one of the morning 
feedings regularly. This will guard against any 
return of the disease. 



CHAPTER XXVIII 
KICKETS 

Eickets is primarily traced to some error in 
feeding. It appears in infancy and early child- 
hood, most commonly between the ages of six 
months and two years. Its duration is from three 
to fifteen months. 

It is encountered more often in the winter 
months than in the summer and in the large 
cities more than in the smaller towns and the 
country. This is due, no doubt, to the greater 
prevalence in congested districts of contaminated 
milk, spoiled food and lack of sunshine and fresh 
air and to more general unhygienic surroundings. 

The bottle-fed baby and the one only partially 
breast-fed are much more subject to this disease 
than the baby fed entirely at the breast. When 
rickets occurs in the breast-fed baby it is due to 
nursing too long, after the tenth or twelfth 
month; and if nursing is prolonged to the fif- 
teenth month rickets is very liable to develop. 
It is also due to breast-milk deficient in fat and 
protein, and more often to breast-milk deficient 
in fat alone. 

S04 



RICKETS 305 

In large cities, among certain nationalities, 
especially those races native to a warmer climate 
and transported to a colder one, where large num- 
bers of breast-fed babies with rickets have been 
observed and treated, we find upon examination 
that the mother's milk is particularly low in the 
fat and protein elements although the quantity 
of milk may be abundant. 

When rickets occurs after the first year it can 
almost invariably be traced to errors in feeding 
during the earlier months. This is nearly always 
true if the nursing is prolonged after the ninth 
or tenth month. The feeding after the' first year 
of a diet consisting exclusively of milk or starches 
will commonly be followed by the first signs of 
rickets. 

There is a popular idea that rickets is a disease 
of the bones in which the lime salts are deficient. 
This is only partly true as this disease affects 
the muscles, ligaments and mucous membranes, 
as well as practically all the organs of the body. 
Moreover the lime salts are frequently found in 
normal amounts in these children. 

However, the most noticeable change from the 
normal in ricketv children is in the bones of the 
legs and arms. 

The bones grow, as you know, by the develop- 
ment of cartilage at the ends. Cartilage is a soft, 
spongy-like material and in it bone cells are 
deposited which calcify or harden and thus bone 



V 



306 DISEASES OF INFANCY 

is formed. In children with rickets, the carti- 
lage development goes on but something is lack- 
ing in the nourishment to cause the cartilage to 
harden and the bone development is slow. The 
bone remains too soft to support the weight of 
the child and consequently bends under it. Later 
when the normal bone cells develop in the soft 
cartilage and harden into bone we have the per- 
manently bent bones, showing in the legs, spine, 
and the deformed chest. The child's growth is 
stunted simply because the normal development 
which should go on at the ends of the bones in 
the cartilage is arrested, the bone does not 
lengthen and the soft cartilage bends or bows 
out of line. Thus we have the shorter and thicker 
bone, when it does harden, with its curve and the 
child is shorter in stature and oftimes distress- 
ingly deformed. 

Other changes occur. The head is large, the 
bones of the skull remain soft, and the two open 
places, the fontanels, remain open for a long 
time before they close. The stomach and large 
intestine are dilated because through weakness 
the muscles lose their tone and stretch. With 
the deformity of the spine that usually exists 
because those soft bones have bent under the 
body's weight, the abdomen becomes very promi- 
nent. This same flabbiness of muscle prevails 
all over the body and the baby's nervous system 
then becomes affected. He grows restless and 



RICKETS 307 

irritable and sleeps poorly. He frequently has 
convulsions. 

One of the annoying symptoms of rickets is the 
tendency to catarrh of the nose with the so-called 
"sniffles." Bronchitis of a very persistent type, 
a tendency to pneumonia and other lung troubles 
commonly follow this stage of the disease. 

The first signs the mother notices that should 
lead her to be suspicious of rickets is sweating 
about the head when the baby is asleep, perspira- 
tion standing out in great beads. This is also 
noticed in waking hours. Restlessness in the bed, 
kicking off the bed-clothes, little spasms of the 
muscles, also occur. Often, slight disturbances 
will bring on convulsions. The baby will always 
be sickly looking and pale because of the anemia 
which is invariably present. 

Deformity of the ribs is a characteristic symp- 
tom which will be noticed early. There will be 
a bending of the ribs down the front of the chest 
on both sides of the breastbone. This is where 
the cartilage of the ribs has spread out, and 
bone having developed in the spread-out carti- 
lage, little enlargements or beads as they are 
called, can be easily seen and felt beneath the 
skin of the chest. This is known as the "Rachitic 
Rosary." Because of the failure of the bones of 
the chest to lengthen, the chest is narrowed and 
much longer from front to back because of the 
bent or bowed ribs. This makes the breastbone 



r" 



308 . DISEASES OF INFANCY 

very prominent and we have the characteristic 
"pigeon breast." 

The teeth are often delayed for many months 
and when they do appear slowly, are small and 
spongy and decay readily. They should be care- 
fully tended by daily cleaning and as the diet is 
regulated and the treatment for rickets followed 
out they will improve in strength. 

THE TKEATMESTT 

Primarily, as we have said, rickets is due to 
some error in diet. It may come in the baby who 
is over-fed but more commonly does it develop 
in the one who is under-fed. In the over-fed 
baby it comes from the disturbance of digestion 
and the inability to assimilate the proper amount 
of food. Rickets which develops in breast-fed 
babies almost always occurs where the milk is 
low in fat and oftimes in protein. The same 
holds true where the baby is fed on cow's milk. 
Especially is this true if the mixture is too low 
in fat and protein with too great an amount of 
sugar. This error is not uncommonly made. 
Over-feeding of any one or all of the elements in 
cow's milk, with a complete upset of the baby's 
digestion, can readily be responsible for rickets 
because it takes so long, if the disurbance has 
been serious, before we can get the baby to digest 
the proper amount of nourishment. 

The principal thing to do in the treatment of 



RICKETS . :C9 

rickets is to get the baby on a properly balanced 
food. The rules laid down in the volume, The 
Proper Feeding of Infants, give you a clear idea 
of what a properly balanced food consists of. 
Another important feature in the treatment of 
rickets is to bring about a change in the diet. If 
it is possible, and the baby is under nine months, 
he should be given breast-milk. If you have been 
using the prepared baby foods without cow's 
milk, change to raw cow's milk. If you find that 
you have been feeding the baby a formula too 
low in fat you should begin to increase the cream 
in the mixture. If you have been feeding a one- 
sided food, as is commonly done, giving a food 
too rich in sugar, or too rich in starch, you will 
have to promptly reduce these. And at the same 
time see that the other elements, the fat and 
protein, are increased. The one thing that you 
can do to prevent rickets is to avoid over-feeding 
your baby. 

If the baby is old enough to add other articles 
to the diet besides milk it is of great benefit in 
the treatment. The strained vegetables and vege- 
table soups, and mutton and chicken broths, can 
be used earlier than advised in the normal baby 
formulas. You can begin the use of a little 
strained vegetables and vegetable soup as early 
as the fifth month if the baby shows signs of rick- 
ets, using them in very small amount at first, half 
the amounts mentioned in the formulas. At this 



310 DISEASES OF INFANCY 

time you can also begin a half teaspoonful of oat- 
meal jelly in three of the nursing bottles daily. 

Increase this amount as the baby gets older. 
By the sixth month begin to give a little mutton 
broth, and by the seventh month you can cau- 
tiously add a half teaspoonful of beef juice before 
one of the feedings. 

In all babies with rickets, no matter what the 
age, give cod-liver oil. Babies will take a half 
teaspoon three times a day. Older children a tea- 
spoonful morning, noon and night. 

Your physician will prescribe for use with 
the cod-liver oil very tiny doses of phosphorus, 
about one three hundredth of a grain. These two 
remedies are of great value in the treatment of 
rickets and must not be omitted, especially the 
cod-liver oil. 

If your baby shows signs of rickets and you 
have been feeding boiled or condensed milk, 
you should change to the use of raw cow's 
milk. What part this plays we do not know 
except that the value of it seems to lie in chang- 
ing the food. 

Orange juice should be immediately started, 
if not already being used, at the first signs of 
rickets. Give orange juice according to direc- 
tions for feeding the normal baby. 

These babies must have lots of fresh air and 
sunlight; keep them in the open air all of the 
time, weather permitting. They must sleep in 



RICKETS 311 

well ventilated rooms at night. The baby with 
rickets must not be allowed to walk until practi- 
cally all signs of the disease have disappeared, 
because of the danger of bow-legs. A large, thick 
diaper must be avoided for the same reason. Nor 
should he be allowed to creep until the rickets 
have been greatly improved because resting upon 
the hands is liable to bend the bones of the arms. 
Carrying in the same position constantly in the 
arms or lying in the same position in bed should 
be avoided. His head should be turned gently 
from side to side at intervals to prevent it from 
becoming flattened out of shape as the bones 
of the skull are very soft. 

To prevent deformities the muscles of the arms 
and legs should be gently massaged once a day. 
If the baby is kept off his feet and these other 
precautions taken, and he is massaged daily, 
deformities will rarely develop. Where actual 
serious deformities have occurred in babies after 
the third year, they must be taken to an ortho- 
pedic surgeon to have these deformities corrected. 

When these children are strong enough to be 
given a tub, they are greatly benefited by a brine 
bath in which a tablespoonful of salt is used to 
the gallon of water. After the bath the skin 
should be rubbed briskly. Afterward, unsalted 
lard or olive oil rubbed into the skin is of great 
benefit to babies who have not had sufficient fat. 

For babies after the first year, one-half a grain 



312 DISEASES OF INFANCY 

of citrate of iron and quinine given twice a day, 
morning and night just before one of the feed- 
ings, dissolved in a little peach juice or orange 
juice, will greatly help to build up the blood. 
This is necessary as these babies with rickets 
are usually anemic. Lime in the treatment is 
rarely of any benefit. 



CHAPTER XXIX 
DEFORMITIES 

Deformities in children usually have small 
beginnings in infancy or the run-about age, 
and in a large number of cases are due to rickets. 
The early signs of rickets and the treatment are 
taken up in a preceding chapter. 

Where curvature of the spine or deformity of 
the bones has already . taken place, the child 
should be taken to a good surgeon, if possible to 
an orthoepedic surgeon. The appliances, braces 
and massage ; or if necessary, the operation, will 
vary with each case and careful measurements 
must be taken and thorough instructions given 
for individual treatment and the wearing of cor- 
rective splints or other appliances. 

Many cases of deformity following infantile 
paralysis, which in the past were considered 
hopeless, are now being successfully treated, 
and limbs restored to usefulness that were 
despaired of. It takes a long time, great patience, 
perseverance, and special instruction in each case, 
but the present-day orthoepedic surgeons are now 

313 



314 DISEASES OF INFANCY 

keenly alive to the great possibilities in all these 
cases. 

The bones of the growing child are soft and 
it is of paramount importance to teach the child 
to sit up straight and to stand erect. This train- 
ing should be begun at home and be carried on at 
school. It will prevent much curvature of the 
spine, which is found in some schools to exist 
in twenty-seven out of every hundred pupils. 

children's feet 

The bones of the growing foot are very soft, 
many of them in the young child little more than 
cartilage, and they are easily deformed by 
improperly fitting shoes. The most common 
deformities encountered in examining men for the 
army were of the feet. 

When the child first starts to walk he toes in 
naturally. Parents often think this is a deform- 
ity and keep at the child until he walks with the 
toes turned out too far. In walking the foot 
should fall nearly in a straight line, with the toes 
only slightly turned out. If the shoes are the 
right shape, giving plenty of room across the 
ball of the foot so that the toes are not pinched, 
and are long enough, the child will naturally 
walk correctly. As the child grows older special 
care should be taken in addition to the proper 
support for the instep and broadness of the heel 
to allow a firm grip of the ground. With shoes 



DEFORMITIES 315 

carefully selected and fitted, the child's feet do 
not become deformed and he will walk correctly. 
Feet that have been ill-treated as to footwear 
can be greatly benefited by prompt attention to 
the following points which should always be con- 
sidered when buying children's shoes. Stockings 
should also be long enough not to draw up the 
toes and should be darned smoothly about the 
foot. Children should not be allowed to wear 
shoes that have shrunk or stockings that are 
lumpy with much darning. In most every busi- 
ness, efficiency depends largely upon good feet 
and this is wholly a matter of right footwear 
during childhood. Remember these nine points 
in buying shoes and safeguard your children's 
feet. 

1. Get shoes to fit your child's type of foot, shoes 

are made for all kinds of feet. If your shoe 
dealer hasn't the right shoes for your child 
he can send for them. Don't try for the 
sake of expediency, to fit your child's foot 
into a stock shoe designed for another type 
of foot. 

2. Get the carefully constructed shoe made of the 

right material for service which is the best 
economy as it keeps its correct shape 
longest. 

3. See that the greatest width of the shoe falls 

in the right place for your child's foot, 



316 DISEASES OF INFANCY 

across the ball and toes to allow the bones 
of the transverse arch to spread out when 
the weight of the body falls on the foot. 

4. See that the inner side of the sole is built in 

practically a straight line so that the big 
toe is not crooked out of position but may 
lie straight in the shoe, properly supporting 
the front inner part of the big or longi- 
tudinal arch. 

5. See that the heel is broad and low, forming a 

solid foundation for the heel bone of the 
foot and properly balancing the shoe. 

6. See that the sole and heel are of sound leather, 

made to keep their shape and not wear down 
quickly on one side. When uneven places 
appear from wear have them repaired at 
once. Deformities quickly develop from 
run-down and one-sided shoes. 

7. See that the sole under the instep is suffi- 

ciently flexible to allow free play of the 
important muscles which support the instep. 

8. Do not let children wear the out-grown shoes 

handed down by an older member of the 
family, or their own out-grown shoes. 

9. Do not let your children's shoes become mis- 

shapen by being soaked in the rain and mud. 
Provide overshoes and insist on their use. 
Keep the leather of all foot-wear well-oiled 
not only to preserve it but to prevent welts 
and callouses. 



DEFORMITIES 317 

COEEECTIVE EXERCISES FOR ROUND SHOULDERS 
AND FLAT CHEST 

The child who is underweight and not strong 
or the one whose breathing and nutrition are 
interfered with in any way must be watched for 
round shoulders and flat chest. Height, weight 
and chest measurements should be carefully and 
regularly recorded and corrective exercises begun 
at the first signs of weakness. The diet, hygiene, 
and supply of rest and fresh air should be firmly 
managed as directed in the chapter on 
Malnutrition. 

Exercise 1. — Deep Breathing. — Stand with the 
heels together, feet straight or toes turned out- 
ward slightly, and simply raise the chest high, 
centering the thought on the raised chest. When 
this is done the weight of the body falls naturally 
over the ball of the foot, the shoulders fall back 
into place and the abdomen comes in; the head 
is erect the chin in. It is not necessary to say, 
"shoulders back, stomach in, head up." Simply 
say: "Chest up." Eepeat it many times a day. 
Eaise the arms straight up from the sides, elbows 
unbent, and extend them in a straight line above 
the head, palms forward. Next, keeping the 
knees unbent, the arms still extending straight 
up, sweep them slowly downward until they come 
as near touching the floor as can be done with 
the knees unbent. 



318 DISEASES OF INFANCY 

While the arms are swinging slowly down, 
breathe out all the air in the lungs. Hold this 
position for two or three seconds, then slowly 
raise the extended arms forward and up until 
the body comes into the upright position again, 
chest up and arms raised straight above the head. 

While swinging the arms slowly up to this posi- 
tion, breathe in a long deep breath. Hold this 
position two or three seconds with hands 
extended. Then close the fists, flex all the mus- 
cles in the arms, and with clenched fists, flexed 
muscles, and elbows bending out, bring the arms 
down forcibly until the fists rest in front of the 
armpits on either side of the chest and the elbows • 
come as near touching at the back as possible. 

While forcibly bringing down the clenched fists 
hold the breath which in this way is forced to 
the bottom of the lungs, and when the fists rest 
on the chest exhale all the breath in the lungs 
slowly, dropping the hands to the side. Then raise 
the hands straight up to the first position and 
repeat the exercise, expelling the air with the 
downward sweep of the hands; inhaling it with 
the upward sweep of the hands, holding it with 
the downward thrust of the fists, and then exhal- 
ing slowly. 

Repeat this exercise three times the first day, 
morning and night, four times the next day, 
increasing it by one exercise each day until the 



DEFORMITIES 310 

child is taking this exercise twenty times each 
day, morning and night. 

Exercise 2. — Correcting Posture. — Make a flat 
circular bag six inches in diameter; fill it with 
a pound, two pounds or a half-pound of shot, 
acccording to the age of the child. With chest 
up have the child balance the bag on the head 
(for five or ten minutes at first and then increase 
the time), while walking across the room five, ten 
or twenty times and while reading a book. Then 
when walking out-doors, increasing the distance. 
Then when running slowly and easily, again 
increasing the distance. 

Exercise 3. — Stand with the heels together, 
chest up and toes two to four inches from a closed 
door. Keeping the heels flat on the floor sway 
the body forward until the chest touches the door. 
Neither head nor abdomen should touch it. 
Repeat this exercise five, ten and twenty times 
morning and night. 

Exercise 4- — Strengthening the Muscles of the 
Back. — This is valuable for the round shouldered 
child. Lay the child flat on his back on the floor 
or a table, his arms straight beside him. Put your 
hands under his head, raising it an inch or two. 
Have him then arch the entire body from the 
heels to the head. At first he will assist with 
his hands pushed against the floor; later he will 
fold his arms over his chest and without assist- 



320 DISEASES OF INFANCY 

ance easily arch the entire body without tiring 
five, ten, and then twenty times. 

Exercise 5. — For Flat Chest. — Have the child 
lie flat on the floor or a table, face downward, 
arms extended straight beside him. Hold the 
ankles while the child raises the head and chest 
as far as possible, raising the arms with the body, 
the back of the hands toward each other, thumbs 
up. Count one to five, then one to ten, later one 
to twenty. 

Exercise 6 — Hanging from Bar to Strengthen 
Muscles of Arms, Shoulders and Back. — -Arrange 
a firm horizontal bar high enough so that the 
child can swing clear of the floor hanging by his 
hands, and have him practice swinging by his 
hands for five, ten and then fifteen minutes two 
or three times a day. 

Carefully supervise all exercises to see that 
the child does not overtax his strength and that 
he does them correctly in order to derive the 
proper benefit. 



CHAPTER XXX 

ACIDOSIS 

The blood in health is alkaline. If anything 
happens to reduce this alkalinity, causing it to 
approach an acid state, ill health or acute illness 
results. In infants and children many things 
cause the blood to become less alkaline. This 
occurs very commonly in diabetes ; and whenever 
a child develops a severe diarrhea from whatever 
cause the blood rapidly approaches an acid state. 

Many children will appear perfectly well for 
days and weeks at a time and then suddenly com- 
plain of headache and pain in the stomach; 
become pale and suddenly begin to vt>mit, the 
vomiting being severe and continuing for two 
or three days, bringing on extreme exhaustion. 
Everything taken will be vomited and there will 
be a great deal of yellow bile. Very often these 
are nervous children who overdo and get very 
much fatigued. During these attacks the tongue 
will be coated and bright red around the edges; 
the lips will be scarlet and the breath may have 
a sweetish odor. The vomiting gradually sub- 

321 



322 DISEASES OF INFANCY 

sides; the child will appear to be all right for a 
few days or for a few weeks, and then develop 
the same symptoms again. Every time one of 
these attacks comes on the blood is approaching 
an acid state and it is due to the improper diges- 
tion of some article of food which produces an 
auto-intoxication. 

Treatment. — When an attack develops all food 
must be stopped. Alkali must be given in the 
form of bicarbonate of soda. If the vomiting is 
so severe that this cannot be retained in the 
stomach it must be given by the rectum. Use a 
No. 18 American catheter attached to your foun- 
tain syringe. Dissolve one-half teaspoonful of 
bicarbonate of soda in four to six ounces of water, 
according to the age of the child. Introduce the 
catheter seven or eight inches into the bowel ; the 
child lying on the left side with the hips elevated 
a little on a folded blanket. Allow the solution 
to run into the bowel very gradually, by pinching 
the tube, so that the child will be able to retain it. 
The solution should be given very warm and 
repeated every four hours until the vomiting 
ceases. As soon as the vomiting stops the child 
can be given chicken broth, gruel, junket and 
plenty of water to drink. Make the return to 
the regular diet very gradually. About two hours 
after breakfast give five to ten grains of bicar- 
bonate of soda dissolved in water or milk. This 
should be given, after the second year, every day 



ACIDOSIS 323 

for many weeks with the hope of keeping the 
blood alkaline and preventing another attack. 

A good plan is to give an enema of very warm 
water every other day; use one-half teaspoonful of 
bicarbonate of soda in one pint of water. Most 
children outgrow these attacks before the age 
of puberty. 

The mother of a child subject to these recur- 
ring attacks should study the chapters on Intes- 
tinal Indigestion and on Malnutrition. 



APPENDIX 

Feeding by Rectum.— The best foods for rectal 
feeding are Peptonized Beef and Liquid Pepto- 
noids which are proprietary predigested foods 
prepared from beef, milk and gluten, and which 
are obtainable ready for use through your drug- 
gist. 

Skimmed milk is also valuable when rendered 
predigested in the following manner. Obtain 
Fairchild's Peptonizing Tubes containing the 
peptonizing material; add to the skimmed milk 
that is to be used one half of the contents of 
one tube; put this in a double boiler or in a 
bottle and set in a pan of water and keep at a 
temperature of 110° to 120° F. for twenty to 
thirty minutes. This is given through a No. 18 
American catheter attached to a fountain syringe. 
Introduce the catheter seven or eight inches into 
the bowel after having thoroughly oiled it with 
vaseline. Use one ounce at a time for a child 
of one to three years ; two to three ounces every 
six hours after the third year. 

Mustard Poultice. — Use one part mustard with 
three parts flour; for young children use four 
parts flour, and for babies five parts flour. Flax- 
seed meal can be used in place of flour. Add 

324 



APPENDIX 325 

boiling water to make a paste, stir thoroughly, 
spread on a cloth and lay on the skin. It is well 
to have a thin protecting layer of cloth between 
the skin and the poultice to prevent burning. 
The poultice should be kept on until the skin is 
well reddened but not long enough to blister. 
The skin should then be well oiled with olive oil 
or vaseline. The poultice should be a quarter- 
inch thick to retain the heat as long as possible 
and should be put on slowly and carefully so as 
not to feel too hot to the child. 

Flaxseed Poultice. — Add flaxseed meal slowly 
to water that is nearly at the boiling point and 
stir constantly until it reaches the consistency 
of mush. Spread on old cotton or linen and 
bandage on quickly so that the heat will be 
retained. It must not be too hot to burn the 
skin when applied. Eenew in two hours. Adding 
a little oil to the mixture will keep it soft longer. 

Turpentine Application. — ■ This is excellent for 
pain in the stomach caused from gas, colic and 
chilling, especially for children where there is a 
lot of gas in the bowel and it is distended. Use 
a flannel cloth large enough to cover the abdomen 
and wring it out of very hot water in which you 
have put one teaspoonful of turpentine to the 
quart. Change every few minutes. 

Boric-acid Dressing.— This is an antiseptic 
wash and dressing for wounds of all kinds. Put 
two tablespoonfuls of boric* acid crystals in one 



326 DISEASES OF INFANCY 

quart of water and boil five minutes. Wring 
cloths out of this lotion and apply as hot as .can 
be borne. 

Eczema Lotion. — Where the skin is raw and 
oozing dab on with clean bits of cotton several 
times a day the following lotion: 

10 drops of phenol 

1 teaspoonful of ichthyol 

2 teaspoonfuls of zinc oxide 

2 teaspoonfuls of magnesium carbonate 
4 ounces of lime water. 

For dry, crusting eczema, use resinol ointment 
on pieces of lint laid over the eruption, or use 
the following: 

4 grains of salicylic acid 
20 grains of ichthyol 
30 grains of zinc oxide 

2 ounces of rose water ointment. 

If the eruption is on the face, saturate bits of 
lint with this ointment, lay them on the spots 
and cover the face with a mask in which openings 
are cut for the eyes, nose and mouth. This can 
be tied on and will prevent the child from scratch- 
ing and infecting the sores. 

For Bums and Scalds. — Use unsalted lard or 
olive oil, or preferably carron oil (this is linseed 
oil and lime water and can be procured from any 
druggist). The air must be kept out and for 



APPENDIX 327 

this purpose cover the oil with baking soda 
and then bandage loosely with cotton cloth, 
oiled silk or paraffin-paper. Should a child's 
clothing catch on fire smother the flame immedi- 
ately by wrapping the child in any thick woolen 
material on hand, a rug, piece of carpet, table- 
cover, dress-skirt, etc., wrapping the neck first so 
that the flame will not reach upward to the face. 
To do this throw the child on the floor instantly 
so that the flames which always mount upward 
do not reach the face. Never run about or into 
the open air as this only fans the flame. If a 
pitcher of water is handy this is the first thing 
to use. A child badly burned should have the 
clothing cut away bit by bit and only a little of 
the skin dressed at a time to avoid the pain of 
exposing too much surface to the air at a time. 
When the wounds are dressed the blisters must 
be pierced at the outer edge by a needle that has 
been sterilized by holding in a flame. Eedress 
the burn each day with the oil dressing already 
mentioned Bad burns should always be cared 
for by the physician. 

For Ringworm. — Paint over the spots with 
tincture of iodine. Wash the skin all around the 
eruption with tincture of green soap. The fol- 
lowing ointment is also useful: 

One-half teaspoonful of sulphur 
One teaspoonful of tar ointment 
One ounce of unsalted lard. 



328 DISEASES OF INFANCY 

For Boils After Opened, and Wounds After 
Cleansed. — 

40 grains boric acid in 
1 ounce of sterile vaseline. 

Mouth Wash. — A most cleansing mouth wash 
consists of one teaspoonful of table salt dissolved 
in a glass of warm water. Another is : 

5 grains of thymol 
10 grains of borax dissolved in 
2 ounces of alcohol. 

This is for older children and the mouth should 
be rinsed thoroughly after each meal. 

Where the mouth is sore and little ulcers have 
formed use: 

y 2 teaspoonful of sodium borate dissolved in 
3 ounces of water. 

Gently wash out the mouth every four hours 
with cotton wrapped around the finger. 

Cooling Lotion for Hives. — Dab the following 
on the spots two or three times a day: 

y 2 teaspoonful pure carbolic acid 
2 teaspoonfuls of ether dissolved in 
6 ounces of alcohol. 

For Bed Sores or Excessive Sweating of Feet. 
— Wash or sponge with 

6 teaspoonfuls of alum 
8 ounces of alcohol 
8 ounces of water 



APPENDIX 329 

Dandruff. — Bub the scalp daily with the fol- 
lowing lotion: 

10 grains of resorcin 
1 ounce of sweet oil 
3 ounces of alcohol. 

Shampoo the scalp thoroughly twice a week 
with resinol soap or tincture of green soap. 

Blackheads. — Steam the skin with cloths 
wrung out of very hot water and apply a lotion 
of one teaspoonful of resorcin in an ounce of 
white vaseline. 

Pimples. — When the pimples are filled with pus 
they must be opened with a needle sterilized by 
holding in a flame. After pricking, squeeze out 
the pus, using a clean cotton handkerchief, and 
wash with hot water and tincture of green soap, 
rinse thoroughly with cool water and apply with 
a cloth several times a day or at bed-time the 
following lotion : 

iy 2 teaspoonfuls of ichthyol 
2 teaspoonfuls of ether 
6 teaspoonfuls of alcohol. 

Another good remedy is ammoniated mercury 
ointment used after treating the pimples as above 
described. 

Aching Feet or Muscles. — Rub on the feet, 
after soaking them in hot water, or on tired mus- 
cles after a hot bath, the following lotion: 



330 DISEASES OF INFANCY 

1 tablespoonful spirits of ammonia 

1 tablespoonful spirits of camphor dissolved in 

1 pint of alcohol. 

Powder to Dust on Swollen or Tender Feet. — 
Wash the feet in hot water, dry and dust on 
morning and night the following powder: 

y 2 teaspoonful of powdered salicylic acid 
2 teaspoonfuls of powdered boric acid 
1 ounce of powdered starch. 

Gargle. — The following astringent gargle is 
excellent for sore throat and tonsillitis: 

One heaping teaspoonful of tannic acid dis- 
solved in a tumblerful of warm water. Or, gargle 
with equal parts of water and peroxide. When 
the tonsils are swollen, after the gargle paint 
them with pure guaiacol using a piece of cotton 
wound round the end of a clean applicator. 

Fever Mixture. — Take internally to allay 
fever; Five drops of tincture of aconite in one- 
half glass of water for infants; ten to fifteen 
drops in one-half glass of water for children over 
one year; taken in doses of one teaspoonful every 
hour for eight doses. Another fever mixture con- 
sists of: 

iy 2 fluidrachms sweet spirits of nitre 

30 grains citrate of potash 

4 fluidrachms syrup of lemon 

2 fluidounces water. 



APPENDIX 331 

One teaspoonful every three hours for the child 
of one to three years; and two teaspoonfuls for 
children over three. 

Cathartics. — Rhubarb and soda or milk of 
magnesia are used for an alkaline laxative. Use 
any of the mineral oils or the following food lax- 
ative : One pound each of dates, figs and raisins, 
one-half ounce of senna leaves, put through a 
meat grinder three to five times and given in 
required doses at bed-time. (Keep in a covered 
glass jar.) 

Emetics (to cause immediate vomiting) . — Table 
salt, dissolved in luke-warm water. Use as much 
salt as you can dissolve in a tumbler of water. 

One-half teaspoonful of powdered alum stirred 
into syrup or molasses. 

One or more teaspoonfuls of syrup of ipecac, 
repeated in fifteen minutes. 

One teaspoonful of mustard in a pint of warm 
water; have the child drink as much as he can 
get down. 



INDEX 



Abdomen, applications- for pain 
in, 197, 218, 204 
distended with gas, 157, 158, 

199, 208, 216 
discomfort from appendix, 

210 
distended in typhoid fever, 

226 
pain in, 106, 197, 204, 216, 

228, 321 
griping- pain in dysentery, 
203, 204 
Abdominal band for cold, 259 
Abscess (see also ear) 
in chest, 148 
in scarlet fever, 58 
in roots of teeth, 192, 193 
around tonsils, 129 
Accidents (see injuries) 
Acid, avoid in sore mouth, 194 
Acid fruits cause of eczema, 

253 
Acid state, blood in, 220, 321 

water for 24 
Acidosis 321-323 
Aconite, doses in colds for 
different ages, 108 
in measles, 69 
to induce perspiration, 147 
Adenoids, 119, 130 
asthma due to, 152 
backwardness due to, 130- 

132 
bed-wetting due to, 243 
bronchitis due to, 133 
caused by colds, 104 
chronic discharge, sign of, 

111 
curetting 117 
persistent cough caused by. 

116 
removal of, 37, 162 
removed without anesthetic, 

130 
tubercular germs in, 155, 
159, 162 
"Adenoid Face," 131 
Adrenalin in hay fever, 153 
Air, fresh, in convalescence, 
32 



colds, preventative for, 113 

in erysipelas, 249 

in hot weather, for baby, 
221 

in illness, necessity for, 20 

in lungs, 138 

lack of, causing malnutri- 
tion, 37, 39 

treatment in measles, 69 

in pneumonia, 20, 142 

in stomach-trouble, 201 

in tuberculosis, 161 

in whooping-cough, 86 

in quarantined rooms, 28 
Albolene, liquid, to ease 
breathing, 53 

to stop itching, 62 

with menthol, 108 

antiseptic spray, 71 
Albumin in urine, 25, 236, 237 

-water, 197 
Alcohol, in bath to reduce 
fever,' 21 

for sore mouth, 189 

sponging in high tempera- 
ture, 62 
Alimentary canal, diseases of, 

189-213 
Alkali, introducing in system, 
220 

cathartic, 242 

for acidosis, 322 

in kidney trouble, 240, 242 

in water, 24 

(see also soda and milk of 
magnesia) 
Alkalinity of blood, 321 
Alum in vaginal discharge, 245 
Ammonia for insect bites, 255 
Anemia, 293 

in Bright's Disease, 239 

in chronic indigestion, 199 

from decayed teeth, 193 

from diseased tonsils, 122 

affecting eyes, 175 

after illness, 31, 64 

in malnutrition, 37 

in rickets, 307 

in tuberculosis, 166 



332 



INDEX 



333 



Anesthetic, 130 

Animals, causing" asthma, 150 

hay fever, 153 

bites, 255, 256 
Antidotes for poisons, 263-266 
Antipyrin for whooping-cough, 

88 
Antiseptic dressing for 
wounds, 325 

gargles and sprays, 51, 53 
Antitoxin, in diphtheria, 47, 
48-50, 112, 125 

hives after, 254 

in typhoid fever, 227 
Anus, in protruding bowel, 210 

cracks from constipation, 
211 

fissures, 211 
Appendicitis, 209-210 
Appendix, 191 
Appetite, after illness, 32 

notional, 39 

habitually poor, 38 

loss of, from indigestion, 
196 

in tonsillitis, 124 

poor, sign of anemia, 293 

of kidney trouble, 240 

of measles, 66 

of rickets, 306 

of tuberculosis, 157 

of typhoid fever, 224 

poor with frequent urina- 
tion, 241 
Applications, cold for swollen 
glands, 126 

for eyes, 174 

for painful joints, 281 

turpentine, for gas in stom- 
ach, 325 

for stomach pains, 197, 204 

in scarlet fever, 63 

for painful urination, 242 
Argyrol for infected eye, 171, 

174 
Aromatic cascara, 26 
Arsenic, causing hives, 254 

swallowing, 264 

(see Fowler's Solution) 
Arthritis, 277 
Asthma, 149-153 

after whooping-cough, 85 
Astigmatism, 179 
Atomizer for nasal spray, 112 
Awkwardness, sign of St. 
Vitas' Dance, 268 



Bacilli (see germs) 
Backward child, 130, 131 
Bacteria, in malnutrition, 35 

in spoiled food, 214 

(see also germs) 
Baking soda (see soda) 
Barley water, 24, 197 



Basham's mixture as iron 

tonic, 239 
Bath (see also under each dis- 
ease) 

baby's in hot weather, 222 

bran, 23 

for colds, 107, 110 

for convulsions, 266 

disinfecting, 30 

in eruptions, 76, 252 

hot, 24 

mustard, 23, 71, 266 

for restlessness, 21 

for reducing fever, 21-24, 
144 

salt, 22 

in sickness, 21 

soda, 23 

sponge, 21 

starch, 23 

temperature of, 22, 23 

tub, 23 
Bed, in sickness, 17, 21, 26 

covering, 20, 63, 69 

in convalescence, 32 

raising, in hemorrhage, 235 
Bed-sores, 328, 21 
Bed-wetting, 242-245 
Beef juice, in eczema, 251 

in scurvy, 301 
Belladonna, in colds, 109 

in bed-wetting, 245 
Benzoin, tincture, for sore 

mouth, 189 
Bichloride for cleaning in con- 
tagions, 28 
Bicarbonate of soda (see soda) 
Bile, 201 

in acidosis, 321 

backing up, 202 

in food poisoning, 215 

vomiting, 208 
Bile duct, 191, 202 
Bilious indigestion, 201 
Biliousness from eggs, 165 
Birth-marks, 262 
Bites, animal, 256 

insect, 255 

causing hives, 254 

in itch, 256 
Bladder, 241-246 

infection in, 38, 240 

(see also kidneys and pel- 
vis) 
Blackheads, 329 
Blaud's pills, 32, 43, 283 
Blindness, 178 

(see also eyes) 
Blisters on chest, 253 

on feet, 259 

opening with sterilized 
needle, 256 
Blood, anemic in malnutrition, 
36 293 

alkalinity of, 321 



334 



INDEX 



acid state of, 321 
air to improve, 37, 39 
arterial, 286 
blue, 286 
bile in, 202 
circulation of, 286 
circulation weak, 288 
clothing" to improve, 113, 259 
disease of, causing deafness, 

188 
germs kept from, 120 
health improving circulation 

of, 259 
impoverished, 33. 293 
in bowel movements, 203, 208 
after illness, 31, 33 
red, 286 
rest to improve, 31, 34, 35, 

37, 42 
salt bath for circulation, 22 
stagnating, 287, 288 
test of, in typhoid, 227 
tonics for, 33, 34, 43 
venous, 286, 287 
Blue baby, 285 
Body, underdeveloped, 131 

(see also malnutrition) 
Boils, 259, 328 
Bones, brittle, in 

scurvy, 301 
deformed, in rickets, 305, 

313 
in rheumatism, 279 
of feet, 314 

of middle-ear, injured, 186 
painful in rheumatism, 278 
swellings in scurvy, 300 
sun-treatment for, 167-169 
affected in tuberculosis, 158 

Boric acid solution, in baby's 
mouth, 190, 192 

for boils, 259 

for eyes, 171 

in discharging ear, 60, 186, 
187 

in erysipelas, 248 

to relieve itching, 76 

in sore mouth, 194 

in vaginal discharge, 245 

for wounds, 325 
Bowels, bile in stools, 208-209 

bleeding from, 235 

blood in stools, 203, 208, 228 

catarrhal condition of, 205 

clay-colored stools, 201 

cleaning out, 108, 197 

colitis, 205 

constipation, 43, 70, 166 

curds in, 216 

diarrhea, 24, 36, 69, 70, 196, 
198 

dysentery, 203 

gas in, 25, 198 

green stools, 215 



inflammation of, 205 

lubricating, 166 

mucous in stools, 203, 208, 
209 

numerous stools, 203, 215 

obstruction of, 208 

offensive movements, 203, 
215 

opening at once, in sickness, 
25 

painful movements, 203 

perforation of, 224 

peritonitis, 204 

protruding, 210 

running off, 203 

typhoid fever germs in 
stools, 228, 229 

ulcers of, 203, 204 

undigested food in, 216 

watery stools, 209, 215 

whitish stools, 201, 202 

wormlike, stringy masses 
in stools, 205 

(see also intestinal trouble) 
Bow-legs, 306 
Braces, in deformity, 100, 167 

in tuberculosis, 167 
Brain, in tubercular meningi- 
tis, 159 
Brandy, as stimulant, 54, 233 

in freezing and frostbite, 258 

in checking erysipelas, 249 
Breasts, affected in mumps, ,78 
Breath, foul, 192, 196, 199, 213 

shortness of, 85 

Breathing, air needed in rapid, 
142 

in asthma, 150 

adenoids interfering with, 
131 

correct, 317 

difficult, in diphtheria, 46 

exercises, in colds and ca- 
tarrh, 112 

in croup, 114 

gas interfering with, 25 

in hay fever, 153 

nasal obstruction, 152 

painful, in pleurisy, 147 

rapid, in bronchitis, 134 

in pneumonia, 134, 140 

in poisoning, 215 

with lips blue, 288 

in sickness, 20 

in whooping-cough, 82, 83 
Bright's Disease, 236 

in diphtheria, 50 

earliest signs of, 25 

from diseased tonsils, 122, 
123 

in scarlet fever, 58, 59 

Bronchial tubes, 133 

affected by asthma, 149 
inflammation of, 84, 133 



INDEX 



335 



infected by colds, 105 

involved in cough, 116 

irritated after infectious 
diseases, 133 
Bronchitis, 133-137 

asthma, symptom of, 149 

from colds, 105 

complication of measles, 65 
66, 72 

in richitic child, 134 

repeated, causing" tubercu- 
losis, 160 

from diseased tonsils, 122 

in tuberculosis, 133, 160 

in typhoid fever, 230 

in whooping" cough, 84 
Broncho-pneumonia, 138, 140 

tendency to, 69 

when danger of, 84, 105 
Bruises (see injuries) 
Burns and scalds, 256, 326 
Butter, in tuberculosis, 165 

(see also fat)* 
Buttermilk, in diarrhea, 205 

in kidney trouble, 242 

(see also diet) 

Calomel, dosage, 118 
in dysentery, 204 
in food poisoning, 217 
in indigestion, 201 
in pneumonia, 143 
in tonsilitis, 126 
Camphor, in colds, 109 
for insect bites, 255 
for sore mouth, 189 
Camphorated oil to allay pain, 

80 
Candy, when to be given, 38 

(see also sugar) 
Carbolic acid, for disinfecting, 
28, 29, 101 
to gargle and swab throat, 
51, 62 
Car-sickness from eye-strain, 

183 
Cascara for cathartic, 26, 77, 

98 
Castor oil (see oil) 
Catarrh, 110-113 

diphtheria germ causing, 111 
in measles, 66, 69, 73 
prolonged, 85 
in rickets, 307 
in whooping-cough, 82 
Catarrhal jaundice, 202 
Cathartics, 330 

alkali cathartic, 242 
Cereal water in sickness, 25 
Chest, blisters on, 253 

burning sensation in, 117 
deformed, 306 
contracted, 131 
fluid in, 147 



pus in, 148 

sharp pain in, 139, 147 
in tuberculosis, 159 
X-ray of, 160 

(see also tuberculosis, pleur- 
isy and bronchitis) 
Chicken-pox, 75-77 
Chillblains, 258 

Chills, bladder inflammation 
from, 241 
diarrhea from, 22 
in erysipelas, 247 
in influenza, 106 
in pneumonia, 140 
malarial, 295, 296 
mistaken for malaria, 297 
in quinsy sore throat, 129 
sign of rheumatism, 278 
in scarlet fever, 56, 61 
in tonsilitis, 124 
Chin, dropped or underdevel- 
oped, 131 
Chorea (see St. Vitas Dance) 
Cinnamon water in croup, 115 
Circulation (see blood) 
Circumcision for bed-wetting, 

242 
Cleanliness, to prevent dis- 
ease, 67, 68 
in handling milk, 156 
of mouth, 189 
lack of, causing, chafing, 

260 
food poisoning, 220 
itch, 256 
leucorrhea, 245 
sore mouth, 193, 194 
typhoid fever, 223 
necessity in sickness, 21 
value in sick-room, 28 
Climate (see out-door life) 
Clothing, on bed in sickness, 
20, 63, 69 
broad-brim hat after meas- 
les, 70 
cap to prevent earache, 71 
child's in sickness, 20, 30 
coarse, causing erysipelas, 

250 
diapers causing chafing, 260 
diapers in rickets, 311 
in chilblains, 259 
mother's in sickroom, 29 
shoes and stockings to pre- 
vent crippling feet, 315- 
316 
sleeping cap to prevent 

colds, 112 
too heavy, 221, 222 
winter clothing cause of 
colds, 113 
Cod liver oil, 33, 43 

(see also under each dis- 
ease) 



336 



INDEX 



Cold-air treatment, 20 
(see also air) 

Cold packs, 233 

Colds, 103-110 
aconite in, 108 
adenoids caused by, 104, 130 
adenoids causing 116, 131 
asthma following", 149 
belladonna in, 109 
bronchitis caused by, 133 
calomel for, 118 
clearing- nose and throat, 

108 
croup with, 114 
clothing causing, 113 
danger after measles, 72, 73 
danger of pneumonia, 135 
danger of tuberculosis, 160, 

161 
Dover's powder in, 109 
sign of measles, 66, 67 
sign of hay fever, 153 
sign of whooping-cough, 82 
"sniffles" in rickets, 307 

Colic, 199 

flare-up in appendicitis, 210 

Colitis, mucous, 205 
(see also dysentery) 

Collodion for sore lips, 189 
blisters on chest, 253 

Colon, 191 

Congenital blood disease caus- 
ing deafness, 188 

Conjunctivitis, 172, 173, 174 

Constipation, cathartics for. 
331 
affecting nutrition, 37 
beginning illness, 25 
causing cracks in rectum, 

211 
from indigestion, 196 
from lying in bed, 166 
in colitis, 206 
oil for, 43, 70, 166 
soothing bowels in, 206 
stubborn, 43 

Consumption (see tuberculo- 
sis) 

Contagious diseases, care and 
quarantine, 27-34 

Convalescence, importance of 
proper care, 30 
(see also under each dis- 
ease) 
salt bath in, 23 
water drinking in, 32 

Convulsions, 266-268 
in epilepsy, 266 
in food poisoning, 216 
from indigestion, 196 
in measles, 67, 69, 74 
malignant scarlet fever, 58 
mustard bath for, 23 
sign of pneumonia, 140 



in rickets, 307 

in tonsillitis, 124 

in typhoid fever, 228 

from worms, 212 
Corneal ulcers, 180 
Corrosive sublimate in conta- 
gious disease, 28 
Coryza (see colds) 
Cough, 116-118 

antipyrin for, 88 

adenoids causing, 131 

sign of bronchitis, 134 

change of climate for, 72 

creosote to stop, 136 

diatussin for, 88 

sign of measles, 66, 67, 72 

in pneumonia, 140 

persistent, 72 

raising head to decrease, 69 

resorcin for, 87 

tuberculosis causing, 117 

whooping-, 81-89 
Creosote in bronchitis and 

croup, 136 
Crippling from rheumatism, 
279 

(see also deformities) 
Cross-eyes, 175 
Croup, 114-116 

diphtheritic, 47 

membranous, 46 

symptoms in measles, 65 
Croup-kettle, 116 
Cystitis, inflammation of blad- 
der, 241 

Deafness, causes, 59, 104, 188 

treatment, 188 

(see also ear) 
Deformities, 313-320 

exercises for, 317-320 

of feet, 314 

from infantile paralysis, 98, 
313 

in rickets, 306-308, 311, 313 

from rheumatism, 279 
Delicate child, dangers to, 65, 
83, 84 

indigestion in, 196 

salt bath for, 23 

tuberculosis in, 160 
Delirium, in fevers, 143 

in food poisoning, 216 

in scarlet fever, 58 
Dentition (see teeth) 
Diarrhea, causes, 36 

cathartics exciting, 70 

chilling causing, 221 

feeding in, 24 

foods exciting, 69 

from food poisoning, 215 

from indigestion, 196, 198, 
199 

in influenza, 106 



INDEX 



337 



in teething, 190 

in tuberculosis, 157 

serious, in dysentery, 203, 
204 

symptom of typhoid fever, 
224 
Diatussin for cough, 88 
Diet, in acidosis, 322 

in anemia, 294 

in asthma, 149-151 

in bed-wetting 1 , 243 

in bronchitis, 136 

in colds, 113 

in colitis, 207 

in convalescence, 32 

in diphtheria, 52 

on discovering" fever, 26 

in dysentery, 204 

in eczema, 250, 253 

in erysipelas, 249 

in food poisoning, 219 

fluid, in heart failure, 289, 
291 

in hot weather, 221 

in indigestion, 197, 201 

in jaundice, 202 

in infantile paralysis, 98 

in kidney trouble, 238 

in malaria, 298 

in measles, 69, 74 

in pneumonia, 144, 145 

in rheumatism, 272, 280 

in rickets, 308 

in scarlet fever, 61 

in shingles, 2J53 

in sore mouth, 194 

in sore throat, 118 

in St. Vitas dance, 270 

causing scurvy, 302 

during vaccination, 91 

to improve teeth, 308 

in tonsillitis, 127 

in tuberculosis, 165 

in typhoid fever, 231 

in whooping-cough, 86 
Digestion, organs of, 191 

(see also diet and indiges- 
tion) 
Diphtheria, 44-54 
Diphtheritic antitoxin, 48 

croup, 47 

germ causing chronic dis- 
charge from nose, 111 

membrane appearing in ton- 
sillitis, 124 

paralysis, 50, 51 
Dirt, germs in, 155, 156 
Disinfecting, bath, 30 

with bichloride of mercury, 
232 

by boiling, 30 

by burning, 29 

with carbolic acid, 28, 29, 

with formaldehyde, 30 



needle to open blisters, 256 

sick-room, 18, 28 

in sunlight, 30 

in typhoid fever, 232 
Dizziness, from bilious indi- 
gestion, 201 

from eye-strain, 183 

in measles, 74 
Dobell's solution, for gargle 
and spray, 51, 62, 71, 153 
Douche for vaginal discharge, 

246 
Dover's powder for colds, 109 
Drainage, causing malaria, 297 

causing typhoid fever, 229 
Drugs, causing hives, 254 

when not needed, 70 
Dysentery, 203-205 

Ear, 183-188 

adenoids affecting, 131 

bleeding, 74 

blood disease causing deaf- 
ness, 188 

drum, 59, 60, 72, 104 

diseases affecting, 59, 65, 71, 
79, 131, 135 

deafness, 59, 131, 186 

middle-ear trouble, 59, 71, 
103, 128, 183, 184, 185 

pus in, 72, 185, 186 

protecting, 71, 72 

"running," 130, 131 

tube to, from throat, 104, 131 

something in, 183 
Earache, 184 
Eczema, 249-254 

asthma following, 149, 151 

bath in, 23 

in bronchitic child, 134 

lotion for, 326 
Eggs, 41 

biliousness from, 165 
Electricity in infantile paraly- 
isis, 99 

for rheumatism, 281 
Emetics, 331 

Empyema, pus in chest, 148 
Endocarditis, inflamed heart 

lining, 289 
Enema, to clean out bowels, 
108, 197, 201, 217 

soda to stimulate kidneys, 
282 

turpentine in, 234 
Epilepsy, 266-268 
Epsom salts, 238 

for aching joints, 281 

as antidote for poison, 263 
Eruption (see rash) 
Erysipelas, 247-249 

meningitis developing in, 248 

from scratching, 77 
Esophagus, 191 



338 



INDEX 



Eucalyptus, in asthma, 152 
in hay fever, 153 

Eustachian tube, 104, 185, 186, 
188 

Exercise, after convalescence, 
34 
for flat chest, 320 
deep-breathing", 317 
for deformities, 99-100 
for round-shoulders, 317, 320 
for weak back, 319, 320 

Eyes, 170-183 

bleeding* from, 74 

corners infected, 247 

after diptheria, 51 

discharge, 66, 103 

dull and listless, 66, 131 

ice-water for inflamed lids, 

70 
in hay fever, 153 
in measles, 65-70 
puffy eyelids, 237 
yellow in jaundice, 202 

Eye-strain, 176-183 
in malnutrition, 38 

Eye glasses, 175-183 

Face, freckles on, 257 

habitually pale, 131 

pale, pinched and blue, 288, 
289 

sunburn, 257 

swollen, 67, 73, 237, 257 

twitching, 193 
Par-sight, 177 
Pat, removing from food, 251 

more needed, 41, 165 
Patigue, sign of acidosis, 321 

of rheumatism, 271 

causing indigestion, 196 
Pear, in sick child, 17, 20 
Feeding (see food) 
Feet, aching, 329 

care of, 314 

cold with lips blue, 288 

chilblains, 258 

deformities, 314 

shoes, 315 

sweating, 328 

swollen, 237, 330 
Fever, causes of, 26 

baths to reduce, 21-24, 143, 
144 

flaring up and irregular, 240 

food poisoning causing, 215 

heart affected by, 143 

indigestion causing, 196, 199 

inflammation of ear always 
causing, 184 

malarial, 295-298 

malarial in character, 297 

managing, 143 

mixture for, 330 

mounting higher daily, 27 



running late in day, 160 

scarlet, 55-64 

steady, 193 

sudden, 210 

teething causing, 190 
Fever sores, 189 
Fish, germs in, 229 
Fissures, of anus, 211 
Flaxseed poultice, 146, 324, 325 
Flies, spreading disease, 27, 
101, 229 

poisoning food, 222 
Flour, for burns and scalds, 

256 
Flowers, causing asthma, 150 

hay fever, 153 
Follicular tonsillitis, 48 

(see also illustration) 
Fontanels, unclosed in rickets, 

306 
Food (see also diet) 

between meals causing trou- 
ble, 32, 243 

biliousness from, 165 

causing asthma, 149 

causing eczema, 250, 251 

causing hives, 254 

causing indigestion, 195, 198, 
199 

causing malnutrition, 36, 38 

cooking to kill bacteria, 213 

failing to nourish because 
of hidden condition, 36 

for children's table, 39 

for nursing mother in ecze- 
ma, 251 

habitual errors in, 199 

in convalescence, 32 

in illness, 20, 24, 219, 250 

liquid, in swollen glands, 80 

olive oil with meals, 206 

orange juice for baby, 303 

poisoning, 214-222 
Food poisoning, 214-222 

causing rickets, 305, 308 

causing scurvy, 302 

feeding by rectum, 144, 206, 
324 

for school-age, 42 

in tuberculosis, 165 

small quantity to prevent 
gas, 291 

variety needed, 42 

wrong indulgences, 39 
Foreskin, adherent, cause of 

bed wetting, 242 
Formaldehyde lamp or candle, 

30 
Fowler's solution of quinine, 
43, 270, 298, 299 

Freckles, 257 
Freezing, 258 
Fresh air (see air) 



INDEX 



339 



Fried foods, cause of bed-wet- 
ting, 243 
when to strictly avoid, 32, 
42 
Frostbite, 258 

Fruit juice (see also diet in 
each disease) 
in diarrhea, 205 
in eczema, 251, 253 
in rickets, 310 
in scurvy, 299, 301, 302 
Fumigating, after sickness, 30 
after tubercular person, 156 

Gall-duct in jaundice, 202 
Gargle, 51, 53, 62, 127, 330 
Gas, from bilious indigestion, 
201 

affecting heart, 282 

from milk, 25 

in food poisoning, 216 

in intestines, 198, 199 
German measles, 72-74 
Germs (see^ also frontispiece 
and under each disease) 

in contagious diseases, 27, 
34 

entering mouth, 120 

from decayed teeth, 192 

in eye, 170, 171 

on flies, 27 

on floors, 156 

on furnishings, 18 

in kissing, 155 

on toys, 30, 156 
Glands, infected by colds, 105 

of intestine in typhoid, 223 

lancing, in neck, 122 

in mumps, 78-80 

swollen in neck, 57, 126 

in tuberculosis, 159, 160, 162 

in tuberculosis of neck, 122 
Glasses for eyes, 175-183 
Glycerine, phenol in, for ear- 
ache, 184 
Grippe, 103 

germ, 138 

in weak child, 161 

(see also influenza) 
Growing pains, not to be over- 
looked, 272, 292 
Gruels in sickness, 25, 26 
Gum-boil, 192 
Gums, bleeding, 300 

lancing, 192 

in infantile paralysis, 102 

in malnutrition, 37 

sore in teething, 190 

sore, from harshness, 104 

swollen in scurvy, 300 

Habits of health, 18 
Hair, wetting eause of ca- 
tarrh, 112 



Handling the sick child, 19 
Hands swelling, 237 
Hardening, to prevent colds, 

113 
Hay fever, 153-154 
Head, rolling, sign of earache, 
185 

sweating in rickets, 307 
Headache, in acidosis, 321 

from bilious indigestion, 201 

from decayed teeth, 193 

from eye-strain, 183 

in infantile paralysis, 95 

in influenza, 106 

in jaundice, 202 

in measles, 66, 69 

in typhoid fever, 224 

sign of uremic poisoning, 

Zoo 

Hearing (see deafness) 
Heart, anatomy, 285 

diphtheria weakening, 53 

fever weakening, 143 

gas in bowels, affecting, 25 

after illness, 31, 32 

mumurs in, 269, 287 

in pneumonia, 139 

scarlet fever weakening, 60 

sodium salicylate to protect, 
126 

danger from overloaded 
stomach, 145 

tonsillitis weakening, 122, 
126 

tonsils affecting, 122 

rheumatism endangering, 
271, 281, 282 
Heart disease, 284-293 

"blue baby," 285 

leaking valves, 287 

inflammation of lining, 289 

murmurs, 269, 287 

rest imperative, 290 
Heat, affecting child, 221 

affecting food, 214, 215, 221 

sponge for reducing, 22 
Hemorrhage, in typhoid fever, 

224, 228, 235 
Herpes or shingles, 189, 253 
Hip affected in tuberculosis, 

158 
Hives, 254-255, 328 

in diphtheria, 50 

soda bath for, 23 
Hot packs, 282 
Hygiene, 18 

in malnutrition, 35-36 



Ice, over heart, 289 
in nose-bleed, 262 
for quinsy sore throat, 129 
in scarlet fever, 63 
for swollen glands, 126 



340 



INDEX 



Iced drinks causing indiges- 
tion, 195 
Ichthyol, 63 

in catarrh, 112 

ointment in erysipelas, 248; 
in frost-bite, 258 
Iliocolitis (see dysentery) 
Indigestion, 195-201 

asthma from, 149 

acidosis caused by, 322, 323 

in baby, 192 

in hot weather, 196, 221 

bilious, 201 

constipation in, 37 

cough caused by, 118 

from improper feeding, 198 
199 

causing hives, 255 

intestinal, 198 

malnutrition retarding, 35, 
36 

overfeeding, 32 

pharyngitis causing, 117 

from sweets and candy, 38 

from teething, 190 

from unsuitable foods, 36 

whooping-cough causing, 84 
Infantile paralysis, 93-102 
Infection, from boils, 259 

hidden in malnutrition, 37 

getting under skin in 
wounds, 247 

rheumatism following, 278 

causing vaginal discharge, 
245 

(see also under each dis- 
ease) 
Infectious diseases, causing 
anemia, 293 

affecting nervous system, 81 

affecting nutrition, 31 

causing deformities, 279, 
306 

causing paralysis, 50, 93, 102 

heart trouble, 31, 53, 60, 139, 
122, 271 

sickroom in, 18 
Influenza, 103 

difference from simple colds, 
105 

starting with sore throat, 
106 
Inhaling, steam in asthma, 152 

steam vapor in croup, 115 

in whooping cough, 87 

in bronchitis, 136 
Injuries, 170 

Insect bites (see bites and 
rash) 

Intestines, 191 

Intestinal indigestion (see in- 
digestion) 
Intubation, in diphtheria, 47 



Iodine, tincture of, for blisters 
on feet, 259 
for pain in chest, 147 
for erysipelas, 248 
for sterilizing wounds, 256 
Ipecac, syrup of, for croup, 
115 
in bronchitis, 137 
to induce vomiting, 115 
Iron and quinine, for rickets, 

312 
Iron tonic, 32, 42, 43, 54, 64, 

73, 89, 126, 166, 239 
Irrigation, of ears, 60, 72, 184, 
186, 187 
of eyes, 171 _ nn 

of nose and throat, 52, 62, 
125, 128 
Isolation (see quarantine) 
Itch or scabbies, 256 
Itching, menthol to stop, 255 

Jaundice, 201 
catarrhal, 202 

Jaw, difficulty in moving, 58 
glands at angle of, 57 

Joints, braces and casts for, 
167 
in rheumatism, 272, 274, 277, 

278 
sun-treatment for, 167-169 
swollen and painful, 278 
swollen in scurvy, 300 
in tuberculosis, 158, 167 

Kidneys, 236-241 

in Bright's Disease, 236 

after diphtheria, 50, 53 

in diseased tonsils, 123 

pelvis of, 240 

poisons in, 25 

pus in (pyelitis), 240 

in scarlet fever, 58 
Knee, limping, 158 
Kumyss, 231 

Lard, for burns and scalds, 
256 

for nourishment, 311 
Laryngeal diphtheria, 46 
Laxative foods, 200 

(see also under each dis- 
ease) 
Lead-water for eye injury, 170 
Lead and opium wash for 

painful joints, 281 
Leech for injured eye, 170 
Lemonade, 26 
Leucorrhea, 245-246 

in bed-wetting, 242 
Licorice powder, cathartic, 98 
Limbs, bent, 305, 306 

held stiff, 300 
Lime salts in rickets, 305 



INDEX 



341 



Lime water, in stomach trou- 
ble, 197 
with oil for burns, 256 
Linseed oil, for burns, 256 
Lips, scarlet in acidosis, 321 
Liquid albolene (see albolene) 
Liquid peptonoids for rectal 

feeding, 324 
Listerine, mouth wash, 231 
Lithia water, 24, 61, 281 

for kidney trouble, 281 
Liver, 201 

(see also bile and bilious- 
ness) 
Lobar pneumonia, 138 
Lungs, 138 

examination in persistent 

cough, 72, 116, 117 
gas in bowels affecting, 25 
in pleurisy, 148 
in pneumonia, 138, 145 
in tuberculosis, 159 
• X-ray of, 160 
Lymph stream, 120 
Lymphatic glands, 78, 119, 121, 
159 

Magnesium citrate, 217 
Malaria, 295-298 
Malnutrition, 35-43 

acidosis due to, 321-323 

bronchitis resulting from, 
134 

causes, 39, 160 

eyes affected by, 175 

heart damaged from, 292 

malignant measles from, 67 

poisons in system, causing, 
36, 160 

rickets following, 306 

salt bath for, 23 

sign of tuberculosis, 155- 
160 

vaginal discharge in, 245 
Massage, for rickets, 311 

for paralysis, 99 
Mastication, 192 
Mastoid cells, 245 
Mastoiditis, 60, 187 

from ear infection, 186 

operation for, 187 
Masturbation, 245 
Meals, at children's table, 39 

at different ages, 38, 42 

(see also diet) 
Measles, 65-74 
Meat, beef juice in eczema, 251 

in rheumatism, 272, 273 

poultry and lish considered 
as, 200 

quantity needed, 41 

after sickness, 32 

ptomaine poisoning, 214-222 



Medicine giving, in sickness, 

20 
Membranous croup, 46 
Meningitis, from erysipelas, 
248 
tubercular, 159 
Menthol, to stop itching, 255 

in spray, 71, 108, 153 
Miliary tuberculosis, 157 
Milk, amount needed, 40 

appetite poor from too 

much, 38 
boiling in epedemics, 127, 
229 

in tubercular family, 156 
in scurvy, 299, 302 
carrying tuberculosis, 156 
in sickness, 25, 26 
in vomiting, 234 
cream, in baby's, 198 
gas in bowels from, 25 
mother's, analyzing, 199 
too poor, 305 
too rich, 199, 250 
omitting in typhoid fever, 

25 
pasteurized, 156, 220 
poisoning from contami- 
nated, 214 
protein-, 205 
rectal feeding of condensed, 

144 
rickets from, 304 
skimmed for sick baby, 197 
typhoid fever germ in, 223, 

229 
whole-milk in feeding, 198 
(see also diet) 
Milk of magnesia, as cathar- 
tic, 26, 77, 80, 197, 201 
introducing alkali, 242 
in food poisoning, 217 
to reduce acid state, 250 
after swallowing poison, 
263, 264 
Mind, sluggish, 130, 131 
Mineral oils, 26 

(see also oils) 
Molasses to induce vomiting, 

115 
Mosquito carrying malaria, 

295, 296 
Mouth, diseases of, 189-195 

bitter taste in, 201 
Mouth-breathing, 130, 131 
Mouth-wash, 328 
Mucous colitis, 205 
Mumps, 78-80 
Muscles, aching, 329 

held rigid in appendicitis, 

209 
sore, in chicken-pox, 75 
heart, 284 



342 



INDEX 



in infantile paralysis, 94, 95 
sore, in influenza, 106 
soreness in neck, 129 
flabby in rickets, 306 
spasms in rickets, 307 
twitchings from decayed 

teeth, 193 
in St. Vitas' dance, 268 
sore, in tonsillitis, 124 

Mustard plaster, 324 
in asthma, 152 
in bronchitis, 135 
in pleurisy, 146 
in pneumonia, 143 
in scarlet fever, 63 

Mustard water, for bath, 23, 
71, 266 
to cause vomiting', 115, 263 

Nausea, from bilious indiges- 
tion, 201 

sign of poisoning-, 238 

(see also vomiting) 
Near-sighted eyes, 178 
Neck, stiff, in sore throat, 129 

in mumps, 78-80 

in infantile paralysis, 96 

in rheumatism, 275 

swollen, 160 

in tuberculosis, 159 
Nervous system and nervous- 
ness, asthma excited by, 
150 

in anemia, 293 

in convalescence, 32 

from eyestrain, 38 

keep nervous child from 
nervous people, 269 

in food poisoning, 216 

care in illness, 31 

causing indigestion, 196 

in infantile paralysis, 99 

in malnutrition, 38 

out-door sleeping for, 269 

sponging- for, 22, 62 

sedative for relief of, in 
measles, 69 

strong sedatives affecting, 
87 

symptom of acidosis, 321 

from decayed teeth, 193 

in tuberculosis, 159 

in whooping-cough, 84 

from worms, 212 
Nitro-glycerine, in uremic 

poisoning, 238 
Nose, adenoids in, 104, 117, 130 

in asthma, 152 

blowing properly, 108 

care in colds, 108 

chronic discharge, 110, 112, 
131 

ear trouble from hard blow- 
ing, 185 



growths or bones in, 112, 
262 

infecting when sore, 247 

picking, 212 

poking something in, 111 

running, 71, 130, 153 

spraying, 51-53 
Nose-bleed, 74, 262 

in typhoid fever, 230 

from growths, 262 
Nurse, clothing of, 29 

in contagious disease, 27 
Nursing, in sickness, 17, 27, 31 
31 

baby in bronchitis, 136 

baby in eczema, 250 

baby, when dangerous, 156 

baby, when difficult to 
breathe, 130 

baby, too long, cause of in- 
digestion, 199 

cause of rickets, 304 

bottles and nipples causing 
sickness, 194 

mother's food in eczema, 251 

(see also instructions under 
each disease) 
Nutrition, bad air affecting, 37. 
39 

blood affected by, 293 

constipation affecting, 37 

eye-strain affecting, 38 

heat affecting, 221 

nervousness affecting, 38, 
196 

poisons in system affecting, 
36, 160 

rest affecting, 37, 42 

teeth affecting, 26 

tonsils and adenoids affect- 
ing, 119 

wrong feeding affecting, 32, 
36, 38, 39, 42, 199, 215, 243 

(see also malnutrition) 
Nux vomica, for bed-wetting, 
244 

Oatmeal water for sick baby, 

24 
Odors, causing asthma and 

hay fever, 153 
Oil, castor, to clean out bow- 
els, 25 

in croup spasm, 116 

in indigestion, 197 

in dysentery, 204 

for worms, 212 

caron (linseed oil and lime 
water) for burns, 256 

of Chenopodium for worms, 
213 

Cod liver, for tonic, 33, 43 

in rickets, 319 

mineral, for constipation, 



INDEX 



343 



43, 70, 166 

for cracks around anus, 211 

olive, to soothe bowels, 206 

to cleanse skin in eruptions, 
252 

to stop itching-, 62 

after plasters and poultices, 
135, 325 

for poorly nourished, 41, 145, 
165 

in food poisoning-, 217 

after swallowing poison, 
263, 265 

for peeling- skin, 62 

in tuberculosis, 165 

for rickets, 311 

of Wintergreen, for rheum- 
atism, 281 
Oleoresin of male-fern for 

tapeworm, 213 
Open-air school, for tubercu- 
lar child, 137 
Operation, for removing ade- 
noids, 130 

tonsils, 123 

for appendicitis, 209 

for mastoiditis, 209 

rest after, important, 32, 
123, 276 

useless, to clip part of ton- 
sils, 274 
Orange juice, in eczema, 251 

for rickets, 310 

in scurvy, 299, 301, 302 
Out-door life, change of cli- 
mate, for asthma, 153 

for Bright's disease, 239 
, for bronchitis, 137 

for persistent cough, 72 

for hay fever, 154 

for rickets, 310 

for tuberculosis, 269 

croupy child guarded in, 114 

dampness, 72 

after illness, 86 

raw or windy weather, dan- 
gers of, 72, 86 

rheumatic child in, 276, 277 

stomach trouble benefitted 
by, 201 

sun-treatment for tubercu- 
losis, 167-169 
Out-door sleeping, 269 
Ovaries, affected in mumps, 

78 
Oysters, carrying germs from 
drainage, 229 



Paleness, from poor appetite, 
38 
lack of fresh air, 37 
from poor blood, 293 
sign of heart trouble, 288 



in St. Vitas' dance, 269 

sign of tuberculosis, 160 
Paralysis, in diphtheria, 50 

electricity for, 99 

exercise for, 99-100 

infantile, 93-102 

of palate in diphtheria, 50 
Parotid glands in mumps, 78- 

o0 

Pelvis of kidneys, 240 

pus in, 38 
Peppermint water for stom- 
ach-ache, 197 
Peptonoids for rectal feeding, 

144 
Peptonized beef for rectal 

feeding, 324 
Peritonitis, 204, 224 
Peritonsilar abscess, 129 
Peroxide of hydrogen, 101, 127 
Perspiration, from indigestion, 
196 
in malaria, 296 
in scarlet fever, 58 
in tuberculosis, 160 
Pharyngitis, 117 
Phenol in glycerine for ear- 
ache, 184 
Phosphorus for rickets, 310 
Pigeon-toes, 314 
Pimples, 329 (see also rash) 
infected by fingernails, 77 
character of in small-pox 
and chicken-pox, 77 
Pirquet von, test for tuber- 
culosis, 37, 117, 160 
Plaster, on chest in pleurisy. 
146, 147 
(see also mustard and flax- 
seed) 
Play, too much, 39 
Pleura, 139, 159 
Pleurisy, 146-148 
cough in, 117 
sharp pain in chest, 139 
Pneumococcus germ, 138 
Pneumonia, 138-145 

complication of bronchitis, 

135 
of measles, 65 
of pleurisy, 145 
of tuberculosis, 161 
of typhoid fever, 230 
cold-air treatment for, 20 
cool sponge, for, 22 
from diseased tonsils, 122 
precautions against, 71 
Poisons, antidotes for, 263-266 
from decomposing food in 

bowels, 25 
thrown off through bowels, 

26 
through pores of skin, 21 
in urine, 25, 240, 241 



344 



INDEX 



from wrong: foods, 199 

swallowing, 263-266 
Poisoning-, from food, 214-222 

ptomaine, 214 
Posture, teaching correct, 314 

exercises for, 317, 319, 320 
Potash, chlorate of, for sore 

mouth, 195 
Potassium acetate in kidney 
trouble, 240 

bromid, in croup, 115 

permanganate, for sore 
mouth, 194 

for vaginal discharge, 246 
Predigested foods for rectal 

feeding, 324 
Prickly heat, 255 

soda bath for, 23 
Proprietary food, 198 
Protein, foods, prolonging 
fever, 232 

-milk, 205 
Ptomaine poisoning, 214-222 
Pulse, after illness, 32 

rapid, affecting heart, 143, 
288 

sign of measles, 66 

in St. Vitas' Dance, 269 

in rheumatism, 269 

rapid, irregular, 288 

slow, 288 

rate at all ages, 290 

weak and rapid in scarlet 
fever, 62 
Pus, from boils, spreading, 259 

in chest, 148 

in ear, 59, 72 

in eyes, 171-173 

in glands, 57 

in kidneys, 240 

in abscess around tonsils, 
129 

in urine, 

Pyelitis, 240 
Pylorus, 191 



Quarantine rules and care,, 27 
in chicken-pox, 76 
diphtheria, 51 
erysipelas, 248 
infantile paralysis, 98, 

101, 102 
measles, 68, 74 
mumps, 79 
scarlet fever, 60 
streptococcus sore 

throat, 128 
tonsillitis, 125, 127 
whooping-cough, 85 
Quassia, infusion of, for 

worms, 212 
Quinine, causing hives. 254 



given in error, 297 
for malaria, 298 
Quinsy sore throat, 129 



Rash, on abdomen, 226 
blisters on chest, 253 
in chicken-pox, 75-76 
from chilblains, 258 
diphtheritic, 50 
dusky, livid red, 58 
drugs causing, 254 
eczema lotion for, 326 
in erysipelas, 77 
in hives, 254 
itching remedy, 255 
infecting by scratching, 77 
in measles, 67, 68, 73 
receding in measles, 71 
pimples, 329 
from poison ivy, 257 
rose colored spots, 226 
from sand-fleas, 254 
in small-pox, 77 
in sore -mouth, 190 
stomach-, 260 

Rectal feeding, 144, 206, 322, 
324 

Rectum, fissures, 211 

itching from worms, 212 
prolapse of, 210 

Resinol ointment for eczema, 
326 

Resorcin, in croup, 87 
spray for throat, 87 

Rest, in illness, 17 

in digestive troubles, 201 
in malnutrition, 37, 42 
(see also under each dis- 
ease) 

Restlessness, sign of anemia, 
293 
from indigestion, 196 
from too much milk, 25 
sign of measles, 66 
of rickets, 306, 307 
of worms, 212 

Rheumatism, 271-283 
arthritis, 277 
inherited, 134, 149, 151 
heart failure following, 284 
following scarlet fever, 60 
sodium salicylate as protec- 
tion from, 126 
St. Vitas' dance following, 

268 
from decayed teeth, 193 
from diseased tonsils, 122 

Rhubarb and soda, 26, 118, 201, 
202 

Rickets, 305-312 
in bronchitis, 134 
delayed teeth in, 190 



INDEX 



345 



with scurvy, 299 

in whooping-cough, 84 

Ringworm, 260, 327 

Round worms, 212 

Saliva, glands secreting-, 78 
Salt, normal solution, in diph- 
theria, 53 
for earache, 184 
in scarlet fever, 62 
in tonsillitis, 125 
in bath to reduce fever, 144 
Salt, and water to induce vom- 
iting, 115 
omitted in all cooking in 
Bright's disease, 239 
Santonin, for worms, 213 
Scalds, 256 

Scalp, dandruff on, 261 
eczema on, 261 
ringworm on, 261 
Scarlet fever, 55-64 
Scarletina (same as scarlet 

fever) 
Schick test for diphtheria, 50 
School, adenoid child back- 
ward in, 132 
open-air, 137 

when to take child out im- 
mediately, 42, 107, 152, 173, 
175, 244, 260, 269 
Screens, necessary, 214, 222 
in infantile paralysis, 98 
in sick-room, 19 
in malarial districts, 297 
Scrofula, 159 
Scurvy, 299-303 

confused with rickets, 299 
Sedatives, in whooping-cough, 

87, 88 
Serum, immunizing dose in 
diphtheria, 51 
for hay-fever, 154 
(see also vaccination and 
antitoxin) 
Sewers, leaky, causing typhoid 

fever, 229 
Shampoo, 329 
Shingles or herpes, 253 
Shoes, to prevent foot trou- 
bles, 315-316 
Sick-room, 18 

in contagious disease, 27, 28 
disinfecting, 30 
Sight (see eyes) 
Silver nitrate for eyes at birth, 
173 
for sore mouth, 189 
Sitz bath, in vaginal dis- 
charge, 245 
Skin diseases, 247-262 
(see also rash) 
bleeding areas under, 300 



excoriated by nasal dis- 
charge, 104 
infection getting in 
scratches and wounds, 247 
oozing, 249 
yellow, 201 (see also bile and 

jaundice) 
raised and swollen, 247 
salt bath stimulating, 22 
Sleep, amount required, 42 
talking in, 199 
(see also rest) 
Sleeping-porch for sick child, 

162 
Sleeplessness, from indiges- 
tion, 196 
in malnourished child, 35 
mustard bath for, 23 
sponge bath for, 21 
Small-pox, protection against, 
90-92 
symptoms and character of 
eruption, 77 
Sneezing, in cold, 103, 107 
sign of hay fever, 153 
sign of measles, 66, 72 
sign of whooping-cough, 82 
Soap, value for cleansing, 21 
for skin eruptions, 252 
for scalp in dandruff, 261 
strong, causing eczema, 250 
Soda, bicarbonate of or bak- 
ing, for acidosis, 322 
in asthma, 151 
in eczema, 253 
in food poisoning, 217 
for hives, 255 
in jaundice, 203 
to stimulate kidneys, 128 
in nursing bottle, 136 
for pus in kidneys, 240, 242 
in rheumatism, 280 
Sodium bromide in convul- 
sions, 267 
Sodium phosphate, in dysen- 
tery, 204 
in jaundice, 202 
Sodium salicylate, in asthma, 
151 
in eczema, 253 
in rheumatism, 280 
in St. Vitas' Dance, 270 
in tonsillitis, 126 
Soil, typhoid germs in, 229 
Sore throat, 118 
calomel for, 118 
diphtheritic, 44-47 
sign of influenza, 106 

of measles, 65-67, 70, 71, 

73 
of scarlet fever, 56, 58, 

62 
of whooping-cough, 87 



346 



INDEX 



patches or spots in, 46, 106, 

127 

Quinsy, 129 

resorcin spray for, 87 

streptococcus, 127-129 
Sores in mouth, 189-195 
Spasm, convulsions, 266 

coughing, 81-89 

epilepsy, 267 

muscle, 268 
Speech, affected by adenoids, 
131 

nasal, 131 

affected by typhoid fever, 
230 
Spinal cord, in infantile pa- 
ralysis, 94 

in tuberculosis, 159 
Spinal fluid, 96 
Spinal puncture, 96 
Spine, brace for, 167 



decaying teeth, 192 

in malaria, 286 

for nourishment in sickness, 

25, 166 
error in adding to milk- 
sugar, 198 
in rickets, 307 
when to avoid, 38, 42 
Sulphur ointment for itch, 256 
Summer diarrhea, feeding in, 
24 
obstruction in bowel mis- 
taken for, 209 
Sun, avoid in hot weather, 221 
Sunburn, 257 
Sun-treatment in tuberculosis, 

167-169 
Sweets (see sugar) 
Swelling, of face, 59, 67, 73, 
78, 237 
of hands and feet, 237, 288 



curvature, 158, 159. 313, 314— — °£ throat, 106 



deformed in rickets, 306 
great pain in, 301 
injury or blow to, 158 
Spleen, 227 
Sponge bath, 21 
Sputum-cups, 29 
St. Vitas' dance (chorea), 268 
Starch, for burns and scalds, 
256 
to much, cause of rickets, 
305 
Steam for colds and croup, 115 
Stimulant, for heart, 63 233 

for kidneys, 63 
Stitch-in-side, 146 
Stomach, fermentation in, 186 
overloaded, causing cough, 
118 

causing heart trouble, 
145 
eye- strain affecting, 183 
relative size and position, 

191 
washing out, 197, 217 
(see also abdomen and in- 
digestion) 
Stomach-ache, 196 
applications for, 197 
peppermint for, 197 
Stomach-cough, 117 
Stomach-rash, 260 
Stools (see bowels) 
Stoop-shoulders, 134 

exercises for, 317, 320 
Streptococcus sore throat, 127- 

129 
Strichnine, in bed-wetting, 

244 
Study, too much, 39 
Styes, 171 

Sugar, in bed-wetting, 243 
causing eczema, 251, 253 



m 



of stomach (see gas) 
of joints and limbs 
scurvy, 300 
Syrup, for cough, 117, 118 
to induce vomiting, 115 



Tape-worm, 213 

Tartar emetic, in bronchitis, 

137 
Teeth, brownish accumulation 
on, 226 

crooked, 131 

decayed, 192 

delayed, 190, 308 

diet to improve, 308 

first or "milk," 190 

grinding, 69, 199, 212 

gums swollen over, 300 

care, in infantile paralysis, 
102 

malnutrition from, 36 

prominent, 131 

rheumatism from, 274 

spongy, 308 
Teething, 190, 192 
Temperature, body, normal, 26 

disclosing ear infection, 184 

taking regularly, 26 

by rectum, 26 

in sick-room, 20 

(see also fever and under 
each disease) 
Tent for sick child, 162 
Thermometer, needed, 20, 26, 

27 
Thirst (see water) 
Throat (see also sore) 

adenoids affecting, 116 

gargle for, 127 

how to irrigate, 125 

infection spreading in, 127 
Thrush, 194 



INDEX 



347 



Tiredness, in convalescence, 
30-34 

sign of malnutrition, 35 

sign of measles, 66 

sig-n of rheumatism and 
heart trouble, 271 
Tongue, coated, in acidosis, 
321 

in indigestion, 106, 199 

in jaundice, 201 

in scarlet fever, 56 

bright red around edges, 321 

"strawberry," 56 
Tonics, after illness, 34, 64, 72, 
137 

brandy, 54 

cod liver oil, 33, 43 

for poor blood, 294 

food, rest and fresh air in 

place of, 35 

iron, 32, 42, 43, 54, 64, 72, 89, 
126, 239 

in rheumatism, 283 

in tuberculosis, 166 

salt bath, 22 
Tonsils, 119-124 

in asthma, 152 

in bronchitis, 133 

in persistent cough, 117 

in colds, 103 

chronically diseased, 120 

clipping useless, 274 

in diphtheria, 46, 47 

in malnutrition, 36 

in measles, 73 

in quinsy sore throat, 129 

in rheumatism, 273 

removal, 32, 37, 123, 162, 274 

scars and sores on neck 
from, 122 

tubercular germs in, 155, 
159, 162 

white spots and patches on, 
46, 106, 124, 127 
Tonsillitis, 119, 124 

calomel in, 126 

affecting heart, 122, 284 

rheumatism following, 273 

sodium salicylate in, 126 
Toys, germs on, 156 
Trachoma, 174 
Tubercular meningitis, 159 

peritonitis, 157 
Tuberculin, test, 157, 160, 161 

doses of, 169 

Tuberculosis, 155-169 

casts and braces for affected 
joints, 467 

child of tubercular parent- 
age, 156 

in glands of neck, 122, 159 

after measles, 65, 66, 72 

military type, 157 



von Pirquet skin test for, 
37, 117, 157, 160, 161 

with pleurisy, 146 

typhoid type, 157 

from diseased tonsils, 122 

spine affected by, 167 

sun-treatment for, 167-169 

after whooping-cough, 84 

X-ray for, 160 
Turpentine, for gas in bowels, 
325 

for pain in abdomen, 197 
Typhoid fever, 223-235 

bladder inflammation in, 241 

milk in, 25 

sponge for, 25 

vaccine for, 230 



Ulcers, of bowel, 203, 204 

in eyes, 180 

on feet, 259 

in month, 194, 195 

in typhoid fever, 224 

started by scratching, 77 
Uremic poisoning, 238 
Uric acid in rheumatism, 272 
Urination, bed-wetting, 242- 
245 

painful, 242 

(see also urine) 
Urine, 25 

albumin in, 25, 59, 236, 237 

blood in, 59 

burning skin, 240 

casts in, 237 

control of, 242-245 

dark-colored, 202 

examinations in sickness, 25 

frequent, 240, 241 

in malnutrition, 37 

pus in, 240, 241 

scanty, high colored, 59, 237 

typhoid fever germs in, 228, 
230 
Urotropin, for kidney trouble, 
242 

in infantile paralysis, 98 



Vaccination, against small- 
pox, 90-92 
in hay fever, 154 
"Vaccine, for typhoid fever, 230 

for whooping-cough, 88 
Vagina, irritated by worms, 

212 
Vaginal discharge, 245-246 

cause of bed-wetting, 242 
Vapo-cresoline lamp in 

whooping-cough, 88 
Vapor for colds and croup, 115 
Vaseline, for adhering eyelids, 
70 



348 



INDEX 



and boric acid to relieve 
itching, 76 

for nose, 154 
Vegetables, carrying- germs, 

229 
Veins, swollen after typhoid, 

230 
Ventilation, in sick-room, 19, 
28 

in sleeping-room, 42 

(see also air) 
Vichy water, 24, 61, 281 
Vision (see eyes) 
Vitamines, in cow's milk, 300 

in mother's milk, 299 

lack of, causing scurvy, 300, 
302 
Voice, nasal, 131 
Vomiting, in acidosis, 321 

in appendicitis, 209, 210 

from biliousness, 201 

in bronchitis, 134 

curds, 196 

fecal matter, 208 

from indigestion, 196, 199 

in influenza, 106 

how to cause, 330 

in jaundice, 202 

milkless diet in, 234 

in obstruction of bowels, 208 

sign of pneumonia, 140 

from food poisoning, 215 

in scarlet fever, 56, 59 

sour, 196 

in teething, 190 

sign of uremic poisoning, 
238 

in whooping-cough, 83, 84 
von Pirquet skin test for tu- 
berculosis, 37, 117, 160 

Warts, 262 

Water, albumin, 197 

barley, 24, 197 

boiling, 156, 229 

cold, on chest, to harden 
child, 113 

drinking, in colds, 109 

in dysentery, 203 

in indigestion, 196 

in kidney trouble, 240, 241 

in rheumatism, 282 



in stomach trouble, 201 
hot, for swollen eyelids, 174: 
for swollen glands, 80 
for moisture in sick-room, 

69 
necessary in sickness, 24 
with turpentine for stom- 
ach-ache, 197 
typhoid fever germs in, 223, 
229 
Water supply unprotected 
causing typhoid fever, 223, 
229 
Weakness, due to anemia, 293 
from lack of fresh air, 37 
from weak heart, 284-293 
renders child liable to bron- 
chitis, 134 

due to tuberculosis, 155, 160 
Weeds, causing hay fever, 153 
Weight, loss of, 38 

in food poisoning, 216 
sign of tuberculosis, 160 
rapid loss of, 203 
Wells causing typhoid fever, 

229 
Welts and callouses, 316 
Whooping-cough, 81-89 

in weak child, 161 
Widal test for typhoid fever, 
227 

Worms, intestinal, 212-213 - 
cause of bed-wetting, 243 

cough, 117 
vaginal discharge, 245 

Wounds, dressing, 328 
danger of infection, 247 
iodine to sterilize, 256 

X-ray of lungs, 160 

Yeast for boils, 259 
Yellow skin, 201, 202 

(see also bile and jaundice) 

Zinc oxide ointment, for chaf- 
ing, 260 
for frostbite, 258 
for skin eruptions, 252 
for sore lips, 139 
Zinc sulphate for infected 
eyes, 174 



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